【摘要】 目的研究胰岛素强化治疗对脓毒症患者预后及血清炎症介质的影响,探讨其可能的机制。方法将40例脓毒症患者随机配对分成胰岛素强化治疗组(n=20)和常规治疗组(n=20)。于入院后采用酶联免疫吸附法(EL ISA)连续检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-10(IL-10)水平,并监测C反应蛋白(CRP)变化。同时记录两组呼吸机使用天数、抗生素使用天数、ICU住院天数、病死率及多器官功能障碍综合征(M ODS)的发生率。结果胰岛素强化治疗组呼吸机与抗生素使用天数、ICU住院天数、病死率、M ODS的发生率均低于常规治疗组。且TNFα-、IL-6、CRP IL-10水平各组均存在时间效应。结论胰岛素强化治疗可改善脓毒症病情,降低病死率,其机制除降血糖、促进合成代谢作用外还可能与其抗炎效应相关。更多还原

【Abstract】 ObjectiveTo investigate the effect of intensive insulin therapy on prognosis and serum inflammatory cytokine levels in patients with sepsis,and to explore the potential mechanism of the intensive insulin therapy.MethodsForty patients with sepsis were randomly divided into intensive insulin therapy group(n=20) and control group(n=20).Enzyme-linked immunoadsorbent assay(ELISA) was used to determine the serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10) and C reaction protein(CRP) after admission.The days of using mechanical ventilation,using antibiotic,and in ICU,mortality and the rats of multiple organ dysfunction syndrome(MODS) were measured during the study.ResultsThe days of using mechanical ventilation and antibiotic,the days in ICU,mortality and the rats of MODS in patients of the intensive insulin therapy group were decreased significantly than those in the control group(P<0.05).Serum levels of TNF-α,IL-6,and CRP in patients receiving intensive insulin therapy were significantly lower than those in patients without the therapy(P<0.05 orP<0.01),but the levels of IL-10 in patients of the intensive insulin therapy group were higher than those in the control group(P<0.05).ConclusionIntensive insulin therapy can improve the effect and decrease mortality of the patients with sepsis.The anti-inflammatory actions of insulin,as well as its glycemia-controlling effects,might favorably contribute to the prognosis of patients with sepsis.更多还原