多发伤患者胰岛素抵抗的临床研究.docVIP

多发伤患者胰岛素抵抗的临床研究 山东省兖矿集团第三医院 山东济宁272072 【摘 要】目的观察多发伤患者空腹血糖(FBG)、胰岛素(FINS)、C肽(CP)、 肿瘤坏死因子(TNF?a)、白介素(IL-8)的变化及意义。方法100例创伤患者， 根据ISS评分，把其分为轻伤(ISS评分＜16分)，重伤(16分le;ISS评分＜25 分)，严重伤(ISS评分匪;25分)。并于伤后1, 3, 5, 7, 9 d晨起空腹抽取肘 静脉血，检测FBG、FINS、CP、TNF?a、IL?8的水平,测算胰岛素敏感指数(ISI), 进行统计学分析，比较各组间差异及其对预后的影响。结果FBG、FINS、CP、TNF-a、 IL?8在伤后早期即升高，3?6 d达高峰后开始下降，三组在伤后的升高程度和持 续时间有显著差异,而ISI是下降的。FBG、FINS、CP、TNF?a、IL?8若下降后再升 高则预示创伤感染及其它并发症的发牛。结论创伤引起血糖升高并存在胰岛素 抵抗(Insulin resistance IR),与创伤的严重程度呈正相关。血清FBG、FINS、CP、 TNF?a、IL?8的动态变化有助于监测多发伤伤情、判断预后和指导临床治疗。 【关键词】多发伤；肿瘤坏死因子-alpha;；胰岛素抵抗；预后 Clin ical observation of in suli n resists nee with multiple trauma patie nts JIANG Qing-he, LIU Guang-xiang, LI Jia-xing. No.3 Hospital of Yan Zhou Mining Group, Jining, 272072, China 【Abstract 】 Objective To observe the variati on and sign 讦 icance of fasti ng blood sugar (FBG), insulin, epeptide (CP), tumor necrosis factor-alpha; (TNF-alpha;) in terleuki n-8 (IL-8) in patie nts with multiple trauma ? Methods Accord i ng to in jury severity score(ISS), 100 patients with mutiple trauma were divided into three groups： slight trauma multiple group (ISS le;16), severe multiple trauma group (16 lt;ISS lt; 25), and extremely severe multiple trauma group (ISSge;25) .The blood was drawn from cubital vein for determination of FBG, FINS, CP, TNF-alpha; and IL-8 were measured at day 1, 3, 5, 7 and 9 after injury, insulin senstive index (ISI) was calculated, compared with the datas of three groups and the in flue nee to prognosis. Results The levels of FBG, FINS, CP, TNF-alpha; and IL-8 in serum of multiple trauma patients in creased sigrdficantly at early stage after trauma, and reached the peak value 3?6d later and then decreased」f the level of serum proinflammatory cytoki nes in crease agai n after decrease, it predict that traumatic inf ecti on or other complications will occure. Con clusi on Fasti ng blood sugar (FBG) of traum patients rose markedly show insulin resistance (IR), There are positive correlation between the increas