不同营养状况慢性阻塞性肺病患者急性期胰岛素测定及其临床意义探讨

Clinical significance and detection of fast blood insulin level in patients of different nutritional status with chronic obstructive pulmonary disease at acute episode.

目的 为了研究慢性阻塞性肺疾病 (COPD)急性发作期空腹血清胰岛素与营养状态的相互关系 ,探讨COPD合并营养不良的机制。 方法 通过人体测量和内脏蛋白测定 ,对 42例COPD急性发作期患者进行营养状况评价 ,同时应用放免法检测其空腹胰岛素水平。 结果 发现中度营养不良组 (B组 )、重度营养不良组 (C组 )空腹胰岛素分别是 12± 7、13±7μU/ml,显著低于营养正常组 (A组 ) 2 7± 17μU/ml(P <0 .0 1) ,C组空腹血糖为 5 .9± 1.5mmol/L ,显著高于A组 4.8± 1.2mmol/L(P <0 .0 5 )。 结论 COPD营养不良患者的内脏蛋白显著下降和脂肪贮存耗竭 ,可能与患者胰岛素分泌不足有关 ,在营养支持中应适当补充胰岛素。

Objective To observe the changes of blood insulin concentration in patients of different nutritional status with chronic obstructive pulmonary disease (COPD) at acute episode. Methods We assessed nutritional status of 42 cases with COPD through body composition measurements and visceral protein detection, and detected their fast blood insulin concentration by radioimmunoassay. Results The insulin levels of mild malnourished patients (group B) and severe malnourished patients (group C) were 12±7, 13±7μU/ml respectively, and lower than the normo-nourished (group A) 27±17μU/ml significantly (P<0.01). The fast blood sugar of group C (5.9±1.5mmol/L) was higher than that of group A (4.8±1.2mmol/L) significantly (P<0.05). Conclusions The paper suggested that inhibition of insulin secretion might be in close contact with lower levels of visceral protein and fat depletion in malnourished COPD patient. As insulin is a protent inhibitor of lipolysis and proteolysis, we suggested that infusion of insulin might be to COPD patient's benefit in nutritional support.