创伤及大手术后感染并发高血糖和MODS患者血浆内毒素与胰岛β细胞功能不全的关系  

Relationship between the Plasma LPS and the Dysfunctions of Pancreatic Islet β-Cell in Posttraumatic MODS Patients with Infection and Hyperglycemia

作　　者：雷万生[1] 王占科[1] 刘龙燕[1] 

机构地区：[1]解放军第94医院外科,南昌330002

出　　处：《江西医学院学报》2006年第4期75-77,79,共4页Acta Academiae Medicinae Jiangxi

基　　金：江西省卫生厅课题(20052044)

摘　　要：目的探讨严重创伤及大手术后感染并发高血糖和多器官功能不全综合征(MODS)患者血浆内毒素与胰岛β细胞功能不全之间的关系。方法创伤后及大手术后感染并发高血糖和MODS患者60例,根据预后情况分为两组:生存组23例和死亡组37例。采用重组C因子基质显色法测定血浆内毒素,用放射免疫法测定血浆胰岛素,用酶法测定血糖。并观察两组患者血浆内毒素(LPS)、稳态模式评估法胰岛素分泌指数(HOMA-β)、糖负荷30min。后胰岛素增量和血糖增量比值(ΔINS30/ΔGLU30)和稳态模式评估法胰岛素抵抗指数(HOMA-IR)变化,并分析血浆内毒素与HOMAβ-,ΔINS30/ΔGLU30和HOMA-IR相关性。结果死亡组血浆内毒素、空腹血糖水平和HOMA-IR均明显高于生存组(P均<0.01),HOMAβ-和ΔINS30/ΔGLU30均明显低于生存组(P均<0.01)。60例创伤及大手术后感染并发高血糖和MODS患者血浆内毒素与HOMAβ-和ΔINS30/ΔGLU30呈明显负相关(r分别为-0.7340,-0.8115,P均<0.01),与空腹血糖呈明显正相关(r=0.7556,P<0.01)。结论严重创伤后感染高血糖MODS患者血浆内毒素在胰岛β细胞功能缺陷中可能发挥重要作用。Objective To investigate the relationship between the plasma LPS and the dysfunctions of pancreatic islet β-cell in posttraumatic MODS patients with infection and hyperglycemia. Methods The levels of plasma LPS , the blood glucose and insulin of fasting and at 30 min post glucose-taken orally in the 23 survival and 37 dead cases of posttraumatic MODS with infection and hyperglycemia were determined. The indexs of HOMA-β , △INS30/△GLU30 and HOMA-IR of both the survival and dead groups were calculated and observed, and the remarkable correlation between the plasma LPS and the indexes of HOMA-β, △INS30/△GLU30 in all posttraumatic MODS patients with infection and hyperglycemia were analysed. Results The plasma LPS, the fasting blood glucose, insulin and the HOMA-IR of the dead group were higher than that of survival group（P〈0.01）, and the HOMA-β and △INS30/△GLU30 of the dead group were lower than that of survival group（P〈0.01）. The plasma LPS were significantly reversely correlated to the index of HOMA-βand △INS30/△GLU30, and significantly direct correlated to the fasting blood glucose and the index of HOMA-IR in all the posttraumatic MODS patients with infection and hyperglycemia（P〈0.01）. Conclusion The plasma LPS may play an important roles in the dysfunctions of pancreatic islet β-cell in posttraumatic MODS patients with infection and hyperglycemia.

关 键 词：创伤 感染 高血糖 多器官功能不全综合征 内毒素 β细胞功能不全 胰岛素抵抗 

分 类 号：R641[医药卫生—外科学] R619.35[医药卫生—临床医学]