严重创伤患者胰岛β细胞功能不全与极化液临床干预效果研究

Studies of the Dysfunction of Islets β Cell and the Effects of GIK Treatment in Trauma Patients

目的探讨严重创伤患者胰岛β细胞功能不全及极化液干预效果。方法260例严重创伤患者(损伤严重评分>16,ISS>16)随机分为极化液5 d干预组(n=140)和治疗对照组(n=120),本院健康体检正常志愿人员作为正常对照组(n=100)。测定各组空腹血胰岛素、血糖、静脉给糖30 min后胰岛素和血糖水平。计算并观察各组稳态模式评估法胰岛素分泌指数(HOMA-β)、糖负荷后胰岛素增量和血糖增量比值(ΔINS30/ΔGLU30)以及胰岛素抵抗指数(HOMA-IR)的变化。结果治疗对照组伤后7 d空腹血糖、空腹胰岛素均明显高于正常对照组,HOMA-β指数和ΔINS30/ΔGLU30比值均明显低于正常对照组,HOMA-IR指数明显高于正常对照组(P<0.01)。极化液5 d干预组伤后7 d空腹血糖明显低于治疗对照组,HOMA-β指数和ΔINS30/ΔGLU30比值均明显高于治疗对照组,HOMA-IR指数与治疗对照组无显著性差别。结论严重创伤患者机体胰岛β细胞功能不全表现为基础胰岛素分泌水平和糖负荷后早期胰岛素分泌水平明显下降。早期使用极化液/胰岛素对胰岛β细胞功能有保护作用。

Objective To studies of the dysfunction of islets β cell and the effects of GIK（glucose-insulin-Potassium） treatment in serious trauma patients. Methods 260 cases of the trauma patients with ISS〉16 were divided randomly into the control（n= 140）,GIK（n = 120）and normal groups（n= 100）. The glucose and insulin of the fasting and 30 min. post of glucose injected of the all groups were determined,and the HOMA-β,AINS30ΔGLU30 and HOMA-IR were calculated and observed. Results The glucose and insulin of the fasting and 30 min. post of glucose injected, the HOMA-IR of the controls group were higher than that of the normal group（P〈0. 01）, but the HOMA-βand ΔINS30/Δof the controls were lower than that of the normal group（P〈 0.01）. The fasting glucose, HOMA-βand ΔINS30/ΔGLU30 of the GIK group were higher than that of the control group, there was no difference of HOMA-IR significantly between the GIK and control group. Conclusion The serious trauma patients represents dysfunction of early phase and basal insulin release of β cell,GIK treatment would be beneficial for the orotect of β cell.