Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan.
Endocr J. 2012;59(5):383-92. doi: 10.1507/endocrj.ej11-0322. Epub 2012 Feb 25.
Periampullary malignant neoplasms have been increasing in Japan, mainly in response to an increase in the incidences of pancreatic cancer, and glucose intolerance due to deterioration of insulin secretion is an important problem. We investigated preoperative parameters to predict postoperative insulin secretion and the need for insulin therapy in patients undergoing pancreaticoduodenectomy (PD). Thirty-six patients with malignant neoplasms of periampullary lesions were enrolled. Preoperative pancreatic parenchymal thickness was evaluated by computed tomography. Insulin secretion and glucose tolerance were evaluated by a 75-g oral glucose tolerance test and an intravenous glucagon loading test. The relationships between postoperative insulin secretion and preoperative parameters and the cut-off values for predicting the need for postoperative insulin therapy for glycemic control were investigated. Pancreatic parenchymal thickness and other preoperative parameters, including the increment of serum C-peptide (Δ C-peptide), fasting plasma C-peptide (F-CPR), insulinogenic index (I.I.) and fasting plasma glucose (FPG), were significantly associated with postoperative insulin secretion. Multiple regression analyses revealed that preoperative Δ C-peptide or F-CPR was the most significant determinant of postoperative insulin secretion, followed by pancreatic parenchymal thickness. In the receiver operating characteristic curve, the best preoperative cut-off values for predicting the need for postoperative insulin therapy were a Δ C-peptide of 0.65 ng/mL, a F-CPR of 0.85 ng/mL and a pancreatic parenchymal thickness of 6.0 mm. Both preoperative insulin secretion and pancreatic parenchymal thickness effectively predict postoperative insulin secretion and identify subjects who need postoperative insulin therapy for glycemic control.
胰头十二指肠恶性肿瘤在日本的发病率呈上升趋势，主要与胰腺癌发病率的上升有关，而由于胰岛素分泌恶化导致的葡萄糖耐量受损是一个重要问题。我们研究了预测胰十二指肠切除术（PD）患者术后胰岛素分泌和胰岛素治疗需求的术前参数。共纳入 36 例胰头十二指肠恶性肿瘤患者。通过计算机断层扫描评估胰腺实质厚度。通过 75g 口服葡萄糖耐量试验和静脉葡萄糖负荷试验评估胰岛素分泌和葡萄糖耐量。研究了术后胰岛素分泌与术前参数的关系，以及预测术后胰岛素治疗以控制血糖的切点值。胰腺实质厚度和其他术前参数，包括血清 C 肽（Δ C 肽）、空腹血浆 C 肽（F-CPR）、胰岛素生成指数（I.I.）和空腹血糖（FPG）与术后胰岛素分泌显著相关。多元回归分析显示，术前Δ C 肽或 F-CPR 是术后胰岛素分泌的最显著决定因素，其次是胰腺实质厚度。在受试者工作特征曲线中，预测术后胰岛素治疗需求的最佳术前切点值为Δ C 肽 0.65ng/ml、F-CPR 0.85ng/ml 和胰腺实质厚度 6.0mm。术前胰岛素分泌和胰腺实质厚度均能有效预测术后胰岛素分泌，并识别出需要术后胰岛素治疗以控制血糖的患者。
