全身炎症反应综合征患者胰岛素强化治疗对血清炎症介质影响.docVIP

全身炎症反应综合征患者胰岛素强化治疗对血清炎症介质影响 　 作者：王弋 许国根 吴锦鸿 赵雪 缪群 陈雯 【关键词】 全身炎症反应综合征：胰岛素强化治疗；肿瘤坏死因子-α；白细胞介素-6；C反应蛋白 研究全身炎症反应综合征患者（SIRS）施行胰岛素强化治疗对体内肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）等早期炎症介质的影响。方法 68例发生应激性高血糖（血糖超过9.00mmol/L）的SIRS患者，配对后随机分为胰岛素强化治疗组和常规治疗组，分别在治疗前和治疗后第1、2和3天抽取肘静脉血3ml，采用酶联免疫吸附法（ELISA）测定血浆TNF-α与IL-6水平，并测定C-反应蛋白（CRP）变化以评估炎症程度。结果 胰岛素强化治疗显著降低了SIRS患者血清TNF-α、IL-6和CRP水平，与常规治疗组比较差异有显著性，（P＜0.05或P＜0.01＝。结论 胰岛素强化治疗可拮抗SIRS患者高炎症状态，抗炎效应可能是除降血糖、促合成代谢作用之外胰岛素强化治疗又一改善SIRS患者预后的重要机制。 关键词 全身炎症反应综合征：胰岛素强化治疗；肿瘤坏死因子-α；白细胞介素-6；C反应蛋白 [] objective To investigate the effect of intensive insulin therapy on serum levels of tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6） and C reaction Protein（CRP）, all of which reflected the inflammatory status in patients with systemic inflammatory response syndrome（SIRS）. Method 68 patients diagnosed as SIRS were randomly divided into intensive insulin therapy group and control group. 3-ml blood was drown from elbow vein in each patient respectively on before therapy and 1nd, 2nd and 3th days’ mornings after their therapy. Enzyme－linked immunoadsorbent assay（ELISA）method was used to determine TNE-α,IL-6 and CRP serum levels. Result serum levels of TNF-α,IL-6 and CRP in patients received intensive insulin therapy were significantly low than those in patients without therapy（P＜0.05 or P＞0.01＝. Conclusion Intensive insulin therapy can attenuate the systemic inflammatory response to SIRS. The anti－inflammatory actions of insulin, as well as its glycemia controlling effects, might contribute to the improved outcomes of patients with SIRS. [] systemic inflammatory response syndrome; intensive insulin therapy; tumor necrosis factor-α;interleukin-6（IL-6）;C reaction protein 临床资料表明，应激性高血糖与患者的预后不良直接相关[1]，胰岛素强化治疗是近年来危重病人血糖控制的有效措施，对降低病死效果显著[2]，日益受到重视。胰岛素强化治疗在纠正负氮平衡的同时，抗炎效应也可能对危重病人机体反应、保护器官功能有益。本研究通过监测全身炎症反应综合征（systemic inflammatory response syndrome SIRS）患者施行胰岛素强化治疗后血清炎症介质水平的变化，旨在进一步探讨胰岛素强化治疗可能产生的抗炎作用。 1 资料与方法 1.1 一般资料：我院急诊ICU和急诊病房2004年9月～2005年8月，收治符合SIRS诊断[3]的患者68例，其中男32