早期目标血糖管理对脓毒血症患者白细胞介素-6和-10表达的影响  

Influence of early target glucose control on interleukin-6 and -10 in septic patients

作　　者：刘超[1] 程青虹[1] 张霞[1] 林笑女 何永来[1] 田培刚[1] 

机构地区：[1]石河子大学医学院第一附属医院ICU,新疆石河子832008

出　　处：《中华实用诊断与治疗杂志》2015年第7期667-669,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：石河子大学科学技术研究发展计划课题(gxji2011-zdgg07-02)

摘　　要：目的 探讨早期目标血糖管理对脓毒血症患者白细胞介素（interleukin,IL）-6、IL-10表达的影响。方法 90例脓毒血症患者按随机数字表法根据早期胰岛素干预治疗后血糖水平分为血糖控制A组（4.4~6.1mmol/L）、血糖控制B组（6.2~8.3mmol/L）、血糖控制C组（8.4~10.0mmol/L）各30例。入住ICU后给予早期目标血糖管理,各组分别在治疗前及治疗后1、3、7d应用ELISA法检测IL-6、IL-10水平。观察各时间点3组患者急性生理学和慢性健康状况Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ）评分、28d病死率、多脏器功能障碍综合征（multiple organ dysfunction syndrome,MODS）发生率及低血糖发生情况。结果 （1）3组治疗前血清IL-6、IL-10以及IL-6/IL-10比值、APACHEⅡ评分比较差异均无统计学意义（P〉0.05）;治疗7d后,血糖控制A组血清IL-6、IL-10、IL-6/IL-10比值、APACHEⅡ评分分别为（22.21±1.53）ng/L、（62.47±11.04）ng/L、0.40±0.09、（12.07±3.55）分,血糖控制B组分别为（25.64±2.34）ng/L、（54.36±12.51）ng/L、0.44±0.14、（15.94±6.87）分,血糖控制C组分别为（32.63±4.08）ng/L、（48.14±10.33）ng/L、0.67±0.13、（15.56±7.53）分;3组IL-10均高于治疗前[血糖控制A组为（45.83±9.89）ng/L,血糖控制B组为（41.52±8.18）ng/L,血糖控制C组为（41.46±8.73）ng/L]（P〈0.05）,血糖控制A、血糖控制B组血清IL-6、IL-6/IL-10比值低于治疗前[血糖控制A组：（32.07±2.39）ng/L、0.74±0.15,血糖控制B组：（31.56±2.32）ng/L、0.75±0.21]（P〈0.05）,且治疗后7d,血糖控制A组IL-6、IL-6/IL-10低于血糖控制C组,IL-10高于血糖控制C组,而血糖控制A组治疗后APACHEII评分低于治疗前[（21.29±5.75）分]和血糖控制B、血糖控制C组治疗后,差异均有统计学意义（P〈0.05）;（2）A组MODS发生率（30.00%）、病死率（26.67%）低于血糖控制B组（43.33%、30.00%）和血糖控制C组（43.33%、33.33%）,�Objective To explore the influence of early target glucose control on the expressions of interleukin （IL）-6 and IL-10 in septic patients. Methods Ninety septic patients were randomly divided into three groups： group A （glucose at 4.4 to 6.1 mmol/L）, group B （glucose at 6.2 to 8.3 mmol/L） and group C （glucose at 8.4 to 10.0 mmol/L）, with 30 patients in each group. After admission in ICU, the patients received early target glucose control. The levels of IL-6 and IL-10 were detected by ELISA technique before and after 1-, 3- and 7-day treatment. At the same time, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）, 28-day fatality, and the incidences of multiple organ dysfunction syndrome （MODS） and hypoglycemia were observed. Results There were no significant differences in serum IL-6 level, IL-10 level, IL-6/IL-10 ratio and APACHEⅡ score before treatment among three groups （P〈0.05）. The serum IL-6 level, IL-10 level, IL-6/IL-10 ratio and APACHEⅡ score were （22.21±1.53） ng/L, （62.47±11.04） ng/L, 0.40±0.09 and 12.07±3.55 in group A, （25.64±2.34） ng/L, （54.36±12.51） ng/L, 0. 44±0.14 and 15.94±6.87 in group B, and （32.63±4.08） ng/L, （48.14±10.33） ng/L, 0.67±0. 13 and 15.56±7.53 in group C after 7-day treatment. The IL-10 levels were significantly higher after 7-day treatment than those before treatment in three groups （（45.83±9.89） ng/L, （41.52±8.18） ng/L, （41.46±8.73） ng/L） （P〈0.05）. The IL-6 level and IL-6/IL-10 ratios were lower after 7-day treatment than those before treatment in group A （（32. 07± 2. 39） ng/L, 0. 74 ± 0. 15） and group B （（31.56±2.32） ng/L, 0. 75±0. 21）（P〈0. 05）. The IL-6 level and IL-6/IL-10 ratio were lower and IL-10 was higher in group A than those in group C after 7-day treatment （P〈0.05）. APACHE 11 score was lower after 7-day treatment than that before treatment （21.29±5.75） in group A and after 7-day treatment in group B and C （P〈0.05）. The in

关 键 词：脓毒血症 目标血糖 白细胞介素-6 白细胞介素-10 

分 类 号：R459.7[医药卫生—急诊医学]