短期强化血糖控制对重症感染合并应激性高血糖患者免疫机能、炎症因子和预后的影响  

Immunological and prognostic effects of short-term intensive glucose control on severe infection complicated with stress hyperglycemia

作　　者：李文武 欧阳艳红[1] 

机构地区：[1]海南省人民医院秀英急诊内科,海口570000

出　　处：《免疫学杂志》2017年第10期896-899,904,共5页Immunological Journal

摘　　要：目的观察重症感染合并应激性高血糖患者短期强化血糖控制的临床效果。方法76例重症感染合并应激性高血糖患者随机分为对照组(n=38)和强化治疗组(n=38)。比较入院1 d及7 d后2组外周血中炎性因子水平及T细胞亚群水平,观察入院第1、3、7天2组患者血糖浓度(FPG)、血糖变异性(GV)及血糖达标时间(TT)等情况。结果入院后7 d强化治疗组患者的CRP、IL-6、TNF-α水平明显低于同期对照组(P<0.05),也低于入院第1天水平(P<0.05);强化治疗组患者外周血淋巴细胞中的CD4^+细胞及CD4^+/CD8^+细胞比例显著高于对照组(P<0.05),同时均高于入院第1天水平(P<0.05);入院第3、7天强化治疗组患者FPG、GV及TT明显低于对照组(P<0.05);Logistic回归分析显示,入院时APACHEⅡ评分和GV可作为结局预测的重要指标。结论短期强化血糖控制能提高重症感染合并应激性高血糖患者免疫功能并改善预后。To investigate the effect of short-term intensive glucose control on immunity function andprognosis in severe infection combined stress hyperglycemia patients, 76 patients with severe infection combinedstress hyperglycemia were randomly divided into control group（whose blood glucose was controlled between7.8-10.0 mmol/L） and intensive group（whose blood glucose was controlled between 4.4-6.1 mmol/L）. The seruminflammatory factor indexes（CRP, IL-6, TNF alpha） and T lymphocyte subsets（CD4~＋, CD8~＋and CD4~＋/CD8~＋） of twogroups were detected on day 1 and day 7 post-admission. The fasting plasma glucose（FPG） levels on the day 1, day3 and day 7 post-admission, blood glucose variability, therapeutic time, case fatality rate and hypoglycemiaincidence were compared between the two groups of patients. The levels of serum CRP, IL-6, TNF alpha on the day7 post-admission in the intensive group were significantly lower than those in the control group, and also lower thanthose levels on the day 1（P〈0.05）. The levels of CD4~＋, CD4~＋/CD8~＋on the day 7 were higher in patients of intensivegroup than those in the control group, and also lower than those levels on the day 1（P〈0.05）. When patientsadmitted to hospital for 3 and 7 days, FPG level of patients in intensive group was significantly lower than that of thecontrol group（P〈0.05）. Hypoglycemia incidence, blood glucose variability, therapeutic time and case fatality rate ofpatients in intensive group were lower than those in the control group（P〈0.05）. Logistic regression analysis showedthat the APACHE Ⅱ score（OR=2.214） and the blood sugar variability（OR=1.375） were independent risk factors forthe death of the patient. In conclusion, short-term intensive glucose control to patients with severe infectioncombined stress hyperglycemia can enhance immune function, and improve the prognosis.

关 键 词：重症感染 应激性高血糖 强化血糖控制 免疫功能 预后 

分 类 号：R459.7[医药卫生—急诊医学]