强化胰岛素治疗对胆源性脓毒症炎症反应水平的影响  

Effect of Intensive Insulin Therapy on Inflammatory Level of Biliary Pyemia

作　　者：蒲长春[1] 周喜贵[1] 胡杰亮[1] 李发平[1] 

机构地区：[1]白银市第一人民医院普外科,甘肃白银730900

出　　处：《中国普外基础与临床杂志》2009年第12期974-977,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨强化胰岛素治疗对胆源性脓毒症TNF-α、IL-6、C反应蛋白(CRP)及APACHEⅡ评分的影响,探讨其可能的抗炎机理。方法2005年1月至2008年12月4年期间我院普外科收治并于24h内实施手术的28例胆源性脓毒症患者,采用随机数字表编号法随机分为强化胰岛素治疗组(强化组,n=14)和常规胰岛素治疗组(对照组,n=14),于术前及术后1、3、5和7d检测2组患者TNF-α、IL-6及CRP水平并计算APACHEⅡ评分。结果强化组术后5和7d的CRP水平及APACHEⅡ评分,术后3、5及7d的TNF-α和IL-6水平均明显低于对照组(P<0.05,P<0.01)。与术前比较,强化组IL-6及APACHEⅡ评分于术后3d开始明显下降(P<0.05),早于对照组。结论强化胰岛素治疗可抑制胆源性脓毒症术后TNF-α、IL-6及CRP的合成,保护受损的肝细胞,降低APACHEⅡ分值和全身炎症反应程度,从而减少MODS的发生。Objective To explore the possible anti-inflammatory mechanism of intensive insulin therapy （IIT） by studying the effect of IIT on the levels of TNF-α,IL-6,C-reactive protein （CRP） and APACHE Ⅱ score in biliary pyemia.Methods Twenty eight patients with biliary pyemia who were admitted by our department and given an operation within 24 h form Jan.2005 to Dec.2008 were randomly divided into two groups by using random number table numbers：one group treated with IIT （IIT group,n=14） and another group treated with routine insulin therapy （RIT group, n=14）. The inflammatory factors, such as TNF-α, IL-6 and CRP were detected dynamically and the APACHE II score was calculated. Results The level of CRP and APACHE11 score on day 5 and 7 and the levels of TNF-α and IL-6 on day 3, 5 and 7 after operation in IIT group were significantly lower than those in RIT group （P〈0.05, P〈0.01）. Compared with preoperative levels, the IL-6 and APACHEH score in IIT group commenced to decrease on day 3 after operation （P〈0.05）, that was earlier than control group. Conclusion The treatment with IIT can suppress the composition of TNF-α, IL-6 and CRP, protect impaired hepatic cells, and reduce APACHEⅡ score, the degree of systemic inflammation and incidence of MODS.

关 键 词：强化胰岛素 胆源性脓毒症 细胞因子 C反应蛋白 APACHEⅡ评分 

分 类 号：R657.4[医药卫生—外科学] R631[医药卫生—临床医学]