严重感染病人胰岛素抵抗的动态变化及其与TNF-α的相关性研究

The dynamic changes of insulin resistance and the correlation between insulin resistanee and serum TNF-α concentrations in surgical patients with sepsis

目的:研究外科感染病人胰岛素抵抗(IR)的意义及其与血浆肿瘤坏死子-α(TNF-α)的相关性,为临床改善和防治感染相关的IR提供理论依据。方法:动态检测外科感染病人血浆TNF-α、空腹血糖(FPG)和空腹胰岛素(FINS),并利用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β),对其和TNF-α进行相关性分析。结果:病人感染早期FINS浓度、HOMA-IR和血浆中TNF-α浓度即开始显著升高,与对照组相比差异显著(P<0.01)。FINS、HOMA-IR与TNF-α呈显著相关(FINSr=0.282,P<0.05;HOMA-IRr=0.260,P<0.05),而TNF-α与单独的血糖和HOMA-β相关不显著(FPGr=-0.002,P>0.05;HOMA-βr=0.190,P>0.05)。结论:外科感染病人血浆TNF-α可作为判断IR程度的预警指标,TNF-α增多在外科感染病人IR中可能发挥重要作用。

Objective ： To investigate the significance of insulin resistance in surgical patients with sepsis and the correlations between insulin resistance and serum TNF-α concentration. Methods：Fasting plasma glucose （FPG） concentration, fasting insulin （FINS） concentration, and serum TNF-α concentration in surgical patients with sepsis were detected dynamically. Insulin resistance index （HOMA-IR） and insulin secretion index （HOMA-β） were calculated using Homeostasis Model Assessment （HOMA）. The correlations between insulin resistance and serum TNF-α concentration were analyzed. Results：At the early phase of sepsis of surgical patients with sepsis, the fasting insulin concentration （9.87 ± 1.17μU/ ml）, HOMA-IR （ 15.52 ± 7.83 ） and serum TNF-α concentration （ 37.48 ± 20.97 ） pg/ml all began to increase significantly （ P 〈0.01, vs. in control group）. FINS and HOMA-IR were all significantly correlated with serum TNF-α concentration , FINS r = 0. 282 P 〈 0.05 ; HOMA-IR r = 0. 260, P 〈 0. 05 ）,while FPG and HOMA-β were not （FPG r =-0. 002 ,P 〉 0. 05; HOMA-β r = 0. 190 ,P 〉 0.05 ） Conclusion ： Serum TNF-α concentration can be as the prewarning target to judge the severity of insulin resistance in surgical patients with sepsis. The increase of serum TNF-α concentration may be play an important role in insulin resistance of surgical patients with sepsis.