强化胰岛素治疗对重症急性胰腺炎患者免疫功能的影响  

Influence of intensive insulin therapy on immune function of patients with severe acute pancreatitis

作　　者：陶少宇[1] 李宛霞[1] 李国平[1] 

机构地区：[1]南昌大学第二附属医院,南昌330006

出　　处：《山东医药》2009年第41期19-21,共3页Shandong Medical Journal

基　　金：江西省卫生厅课题资助项目(20073063)

摘　　要：目的探讨强化胰岛素治疗对重症急性胰腺炎（SAP）患者免疫功能的影响。方法将60例SAP患者随机分为强化治疗组和常规治疗组,强化治疗组目标血糖为4.46.1 mmol/L,常规治疗组为10.011.1 mmol/L。观察两组治疗前后血清TNF-α、IL-6、CD4^＋/CD8^＋及CD14^＋单核细胞人白细胞抗原-DR（HLA-DR）表达率。结果两组血清TNF-α、IL-6浓度治疗后逐渐下降,在第4、7、10天两组比较有统计学差异（P〈0.05）。强化胰岛素治疗对外周血CD4^＋、CD4^＋/CD8^＋影响不显著,两组比较无统计学差异（P〉0.05）。强化治疗组CD14^＋单核细胞HLA-DR表达率恢复缓慢,在第7、10、14天与常规治疗组比较有统计学差异（P〈0.05）。结论强化胰岛素治疗虽然可以减少炎症介质释放,但同时下调CD14^＋单核细胞表面HLA-DR的表达,随着治疗时间增加可能引起免疫麻痹。Objective To investigate the influence of intensive insulin therapy on immune function of patients with severe acute pancreatitis.Methods 60 patients with severe acute pancreatitis were randomly divided into insulin therapy group（maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L） and conventional treatment group（maintenance of blood glucose at a level between 10.0 and 11.1 mmol/L）.The change of serum TNF-α and IL-8 level,blood CD4^＋/CD8^＋ and the human leukocyte antigen-DR（HLA-DR） expression on CD14^＋ monocytes of the two groups were observed before and after the therapy.Results Serum TNF-α,IL-6 levels gradually decreased after treatment,there was statistical difference between two groups on the fourth,seventh,tenth day（P〈0.05）.Intensive insulin therapy had no effect on the change of blood CD4^＋ and CD4^＋/CD8^＋.The HLA-DR expression on CD14^＋ monocytes of insulin therapy group upgraded slowly.Campared with conventional treatment group,the HLA-DR expression of insulin therapy group reduiced obviously（P〈0.05）,on the seventh,tenth,fourteenth day.Conclusions Intensive insulin therapy could reduce the release of inflammatory mediators,but lessen the HLA-DR expression on CD14^＋ monocytes.With the extension of treatment time,it is likely to induce immune paralysis.

关 键 词：胰腺炎 急性坏死性 强化胰岛素治疗 免疫功能 

分 类 号：R576[医药卫生—消化系统]