外科严重感染病人胰岛素抵抗和免疫炎症反应的关系  

The effects of insulin resistance on immunizing inflammatory reaction in surgical critically ill patients with sepsis

作　　者：燕晓雯[1] 李维勤[1] 虞文魁[1] 王晓东[1] 黎介寿[1] 李宁[1] 

机构地区：[1]南京大学医学院临床医院(南京军区南京总医院)解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2007年第1期13-17,共5页Parenteral & Enteral Nutrition

基　　金：军队"十五"科研基金重点项目(01Z011)

摘　　要：目的:研究胰岛素抵抗(IR)对严重外科感染病人免疫炎症反应的影响。方法:选取外科ICU存在严重感染病人40例,确诊感染24 h内入组。入组后24h、48h、72h和4 d、7d采静脉血,测定空腹血糖和胰岛素、血浆细胞因子IL-6和IL-10、外周血单核细胞HLA-DR阳性率,胰岛素抵抗指数(IRI)。采用稳态模式法(HOMA)计算,数据取lgIR I。40例病人共200个lgIRI和HLA-DR对应值,按lgIR I分为三组:无IR组(lgIR I<0.434),低IR组(0.434≤lgIR I≤0.868)和高IR组(lgIRI>0.868)。结果:无IR组32个(16%),低IR组64个(32%),高IR组104个(52%);低IR组HLA-DR明显低于无IR组(P<0.01),高IR组HLA-DR明显低于低IR组(P<0.01)和无IR组(P<0.01);相关分析显示,lgIR I与外周血单核细胞HLA-DR呈显著负相关(r=-0.659,P<0.01)。低IR组血浆IL-6和IL-10浓度明显高于无IR组(P<0.01),高IR组血浆IL-6和IL-10浓度明显高于低IR组(P<0.01)和无IR组(P<0.01),相关分析显示,lgIR I与血浆IL-6(r=0.758,P<0.01)和IL-10(r=0.804,P<0.01)浓度呈显著正相关。低IR组血浆IL-10/IL-6明显高于无IR组(P<0.01),高IR组血浆IL-10/IL-6明显高于低IR组(P<0.01)和无IR组(P<0.01),相关分析显示lgIR I与血浆IL-10/IL-6浓度呈显著正相关(r=0.837,P<0.01)。结论:外科严重感染病人胰岛素抵抗和免疫炎症反应呈密切负相关,在高胰岛素抵抗状态下,感染病人预后不良可能与其免疫功能严重低下有关。Objective： To investigate the effects of insulin resistance on immunizing inflammatory reaction in surgical critically ill patients with sepsis. Methods：Forty severe sepsis cases in SICU were admitted within 24 hours after a definite diagnosis as sepsis was made. Venous blood was drew in 24 h, 48 h, 72 h, 4 d, 7 d and the time of discharging from ICU to detect fasting plasma glucose, fasting insulin, serum IL-6 and IL-10 concentrations. Positive rates of HLA-DR in peripheral blood monocyte cells were detected by flow cytometer. Insulin resistance index was calculated using HOMA. Logarithmic insulin resistance index （lgIRI） was used as data in the study. There were 200 pairs corresponding values in 40 cases. They were grouped into 3 groups by lgIRI： no-IR group （ lgIRI 〈 0. 434）, low-IR group （ 0.434 lgIRI≤0. 868 ）, and high-IR group （ lgIRI 〉 0.868 ） o Results：There were 32 pairs in no-IR group （ 16% ）, 64 pairs in low-IR group （32%）, and 104 pairs in high-IR group （52%）. The positive rates of HLA-DR in peripheral blood monocyte cells in low-IR group were significantly lower than those in noIR group （ P 〈 0.01 ）. The positive rates of HLA-DR in high-IR group were significantly lower than those in low-IR group and no-IR group, respectively （P 〈 0.01 ）. There was significantly negative correlation between lgIRI and rates of HLA-DR in peripheral blood monocyte cells （ r = - 0. 659, P 〈 0.01 ）. The serum concentrations of IL-6 and IL-10 were significantly higher than those in no-IR group （P 〈0.01 ）. The serum concentrations of IL-6 and IL-10 in high-IR group were significantly higher than those in lowIR group and no-IR group, respectively （P 〈 0.01 ）. There were significantly positive correlations between lgIRI and the serum concentrations of IL-6 （ r = 0.758, P 〈 0.01 ） and IL-10 （ r = 0. 804, P 〈 0.01 ）. IL-10/IL-6 were significantly higher than those in no-IR group （P 〈 0.01 ）. IL-10/IL6 in highIR group were significantly hig

关 键 词：感染 胰岛素抵抗 免疫炎症 

分 类 号：R639[医药卫生—外科学]