严重创伤患者早期胰岛素强化治疗对血清炎症介质水平的影响  

Effect of intensive insulin therapy on serum proinflammatory cytokine levels in patients with severe trauma

作　　者：赵晓东[1] 孟海东[1] 姚咏明[1] 闫润民[1] 邓群[1] 何忠杰[1] 彭国球[1] 闫柏刚[2] 梁华平[3] 

机构地区：[1]解放军总医院第三○四临床部急救部,北京100037 [2]重庆第三军医大学西南医院急救部 [3]重庆第三军医大学野战外科研究所

出　　处：《中国危重病急救医学》2005年第7期406-408,共3页Chinese Critical Care Medicine

基　　金：军队"十五"医药卫生科研基金资助项目(01MA207);首都医学发展科研基金重点项目(20032023)

摘　　要：目的研究严重创伤患者施行胰岛素强化治疗对体内肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)等早期炎症介质的影响。方法40例发生应激性高血糖(血糖超过9.0mmol/L)的严重创伤患者〔创伤严重度评分(ISS)≥20分〕配对后随机分为胰岛素强化治疗组和常规治疗组,采用酶联免疫吸附法(ELISA)连续检测72h内血清TNF-α与IL-6水平,并监测C反应蛋白(CRP)变化以评估炎症强度。结果胰岛素强化治疗显著降低了创伤后血清TNF-α、IL-6和CRP水平,与常规治疗组比较差异有显著性(P<0.05或P<0.01)。结论胰岛素强化治疗可拮抗创伤后机体呈现的高炎状态,抗炎效应可能是除降血糖、促合成代谢作用之外胰岛素强化治疗又一改善创伤患者预后的重要机制。Objective To investigate the effect of intensive insulin therapy on serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C reaction protein (CRP), all of which reflected the inflammatory status in patients with severe trauma. Methods Forty patients with severe trauma 〔injury severity score(ISS)≥20〕 were randomly divided into intensive insulin therapy group and control group. Enzyme-linked immunoadsorbent assay (ELISA) method was used to determine the TNF-α and IL-6 levels within 72 hours after admission. Results Serum levels of TNF-α, IL-6 and CRP in patients received intensive insulin therapy were significantly lower than those in patients without the therapy (P<0.05 or P<0.01). Conclusion Intensive insulin therapy can attenuate the systemic inflammatory response to trauma. The anti-inflammatory actions of insulin, as well as its glycemia controlling effects, might contribute to the improved outcomes of patients with severe trauma.

关 键 词：严重创伤 胰岛素 强化治疗 血清 炎症介质 白细胞介素-6 

分 类 号：R641[医药卫生—外科学]