严重创伤患者早期胰岛素强化治疗对外周血IFN-γ和IL-18水平的影响

Effects of intensive insulin therapy at the early stage on IFN-γand IL-18 in serum for severe trauma patients

目的探讨严重创伤患者早期胰岛素强化治疗中细胞因子干扰素(IFN-γ)、白细胞介素-18(IL-18)的变化规律及其相关性。方法选择40例创伤后24 h内出现应激性高血糖(血糖值超过肾糖阈8．96 mmol/L)严重创伤患者(ISS≥20,APACHEⅡ分值近似),随机分为早期胰岛素强化治疗组和对照组,采用放射免疫法和ELISA法分别于治疗后12、24、48、72 h检测两组血浆IFN-γ和IL-18水平。结果严重创伤患者早期胰岛素强化治疗后血浆IFN-γ和IL-18水平明显低于对照组。结论严重创伤患者早期胰岛素强化治疗可以显著降低以血浆IFN-γ为主的炎性介质水平,继而抑制创伤后全身炎症反应综合征的发生与进展,降低严重创伤患者并发症发生率与死亡率。

Objective To explore the expression of interferon -γ（ IFN-γ） and interleukin - 18 （IL- 18） in serum and their effect on the prognosis after intensive insulin therapy in severe trauma patients. Methods 40 severe trauma patients with stress hyperglycemia within 24 hours after trauma were randomly divided into intensive insulin therapy group and control group. Radioimmunoassay and ELISA methods were used to determine the IFN -γand IL- 18 levels 12, 24, 48, 72 h after the treatment. Resuits Levels of IFN -γ and IL - 18 in severe trauma patients were significantly lower in intensive insulin therapy group than in control group. Conclusion Intensive insulin therapy after severe trauma can obviously lower main inflammatory meditors IFN-γ level, inhibit the SIRS and decrease the incidence of comlications and mortality.