严格血糖控制对危重症炎症与免疫状态的影响  

Effect of Tight Glucose Control on Systemic Inflammatory Response and Immune Function during Critical Illness

作　　者：赵京阳[1] 张彤彦[1] 周华[1] 何伟[1] 李彤[1] 赵栋[1] 王超[1] 许媛[1] 

机构地区：[1]首都医科大学附属北京同仁医院ICU

出　　处：《首都医科大学学报》2007年第5期579-583,共5页Journal of Capital Medical University

基　　金：首都医科大学附属北京同仁医院科研基金资助项目~~

摘　　要：目的：了解创伤、感染等应激后重症病人血清CRP（C反应蛋白）、IL-6（白细胞介素-6）、MIF（巨噬细胞移动抑制因子）及外周血单核细胞人类白细胞抗原（HLA-DR）的变化及其与应激性高血糖的相互关系;探讨强化胰岛素治疗对重症病人体内炎症反应与免疫状态的影响。方法：33例收住SICU的重症病人分为3组：血糖控制1组（目标血糖4.44～6.11mmol/L）,血糖控制2组（目标血糖6.66～8.33mmol/L）,对照组（目标血糖9.99～11.10mmol/L）,入选后第1、4、7天测定外周血单核细胞HLA-DR及血清IL-6、MIF、CRP的动态变化。结果：3组病人血清CRP、IL-6、MIF均明显升高,CRP与血糖水平呈正相关（P〈0.05）;外周血单核细胞HLA-DR降低,与血糖水平呈负相关（P〈0.05）。强化胰岛素治疗后,血糖控制1组与对照组相比,血清CRP、IL-6在第7天显著下降（P〈0.05）,血清MIF的下降与对照组差异无统计学意义（P〉0.05）,而HLA-DR明显高于同期对照组水平（P〈0.05）。结论：强化胰岛素治疗将血糖控制于正常水平更有助于增加外周血单核细胞表面HLA-DR的表达,下调应激后重症病人机体内炎症反应状态。Objective To investigate the correlation of stress hyperglycemia with serum levels of C reactive protein （CRP）, interleukin-6（IL-6） and macrophage migration inhibiting factor （MIF） that reflect the inflammatory status and with the expression of human leucocyte antigen DR（HLA-DR） on peripheral monocytes in critically illed patients with trauma or infection; and to investigate the effect of intensive insulin therapy and glycemic control on inflammatory response and immune function in critical illness. Methods Thirty-three critically illed patients were randomly divided into the control group（ maintenance blood glucose at a level between 9.99 and 11.10 mmol/L）, glycemia controlling group 1 （maintenance blood glucose at a level between 4.44 and 6. 11 mmol/L）, and glycemia controlling group 2（ maintenance blood glucose at a level between 6.66 and 8.33 mmol/L）. Critically illed patients with APACHE Ⅱ score ≥ 10 after trauma or infection were enrolled. Patients with insulin-dependent diabetes mellitus, immune disease or history of long-term immunoregulating medicine taking were excluded; patients less than 18 years old were also excluded. Target glycemia was obtained by insulin infusion. The glycemia level was determined every one to two hours. The interval of glycemic measurement might prolong when target glycemia was achieved. The expression of human leucocyte antigen DR on peripheral monocytes was measured in all 33 patients with flow cytometry on 1,4 and 7 of intensive care in parallel with C reactive protein. In the meantime, Enzyme-linked immunoadsorbent assay （ELISA） was used to determine the interleukin-6 and macrophage migration inhibiting factor. The same nutritional support was applied to all patients. Data were expressed as Mean ＋ SD and analyzed by using Analysis of Variance and correlation and linear regression. A p value 〈 0.05 was regarded as statistically significant in all the tests conducted in this study. Results 1 ） The incidence of stress hyperglycemia was

关 键 词：严格血糖控制 强化胰岛素治疗 应激性高血糖 

分 类 号：R446.63[医药卫生—诊断学]