急性高血糖对感染患者激素和细胞因子的影响

Influence of acute hyperglycemia on inflammatory cytokine and counterregulatory hormone cocentrations in human sepsis

目的 观察感染患者伴有或无糖耐量异常时 ,急性高血糖对循环中胰岛素、胰高血糖素、皮质醇、IL 6和TNF α的影响。方法 根据静脉糖耐量试验把 4 0例感染患者分为 :对照组 (糖耐量试验正常组 ,n =2 0 )和IGT组 (糖耐量试验异常组 ,n =2 0 )。两组患者外源性给予葡萄糖使血糖快速升高 ,钳夹血糖于 15mmol L左右 3h。用放免法测定血中胰岛素、胰高血糖素和皮质醇的浓度 ,用ELISA的方法测定血中IL 6和TNF α的浓度。结果 在IGT组中空腹血糖、胰岛素、胰高血糖素、皮质醇、IL 6和TNF α水平要明显高于对照组 (P <0 0 5 )。在葡萄糖钳夹期间 ,对照组所用的葡萄糖量要明显高于IGT组 (P <0 0 1)。在对照组 ,输注外源性葡萄糖后 ,血中的胰岛素水平从基础水平逐渐增高 ,1h后到达高峰 (P <0 0 5 )并维持在较高水平 ;血中的胰高血糖素从基础水平开始下降 ,1h后降至最低 (P <0 0 1) ,并维持在较低水平。在IGT组 ,血胰岛素较对照组升高更明显 (P <0 0 1) ,但血中的胰高血糖素无明显下降。两组患者血中的皮质醇在实验期间无明显变化。在对照组 ,血中的IL 6和TNF α在葡萄糖钳夹的前 2h明显增高 ,3h后恢复到基础水平。在IGT组血中细胞因子的增高持续时间明显长于对照组 (3h比 2h ,P <0 0 1) ,并且细胞因子升高?

Objective TO assess the effects of hyperglycemia levels of insulin,glucagon,cortisol,IL-6 and TNF-α in sepsis patients with normal or impaired glucose tolerance.Methods According to the results of intravenous glucose tolerance test,forty patients were classified into two groups:20 control cases and 20 IGT cases.Plasma glucose levels were rapidly increased in the two groups and maintained at 15 mmol/L for 3 hours.Plasma insulin,glucagon and cortisol levels were measured by radioimmunoassay,and the levels of TNF-α and IL-6 were detected by ELISA.Results In IGT cases,the concentrations of plasma glucose,insulin,glucagon,cortisol,IL-6 and TNF-a levels were significantly higher than those in control cases(P<0.05).During the clamp,the control casess had higher average amount of dextrose infusion than IGT cases(P<0.01).In control cases,plasma insulin level rose from a basal value to a peak at an hour(P<0.05)and maintened at a high level.Plasma glucagon level dropped from a basal value to the lowest level at half an hour (P<0.01),and maintainal at a low level.In IGT cases,plasma insulin were more significantly increased(P<0.01),but plasma glucagon level was not significantly reduced.Plasma cortisol levels were not significantly changed in the two groups.In control cases,plasma IL-6 and TNF-α level rose(P<0.01)within 2 hours of the clamp and returned to basal values at 3 hours.In IGT subjects,the increase in plasma cytokine levels lasted longer than,but in control cases(3 hours vs 2 hours,P<0.01),and the cytokine peak in IGT subjects was higher(P<0.05)than that in control cases Conclusion The increase of acute hyperglycemia can make insulin and cytokines increase rapidly in blood.