胰岛素强化治疗对创伤患者免疫球蛋白、补体及单核细胞噬菌能力的影响

Effects of intensive insulin therapy on serum immunoglobulin, complement levels and phagocytosis of monocytes in patients with severe trauma

目的探讨胰岛素强化治疗对严重创伤患者血清免疫球蛋白与补体水平的变化以及外周血单核细胞大肠杆菌颗粒吞噬能力的影响。方法采用随机配对原则将外科重症加强治疗病房（ICU）收治的创伤严重度评分（ISS）〉20分的严重创伤患者分为胰岛素强化治疗组（目标血糖值4～6mmol／L）和常规治疗组（目标血糖值〈11．1mmol／L）。分别在入院时及入院后2、4、6和8d留取外周静脉血，检测血清免疫球蛋白（IgA、IgG、IgM）与补体（C3、C4）水平的动态变化，全血细胞与用异硫氰酸荧光素（FITC）标记的大肠杆菌共孵育后检测单核细胞噬菌能力。结果两组严重创伤患者血清IgA、IgG、IgM和C3、C4水平在入院时均较低，入院治疗后均开始升高，并在治疗6～8d达到或接近正常范围。胰岛素强化治疗后C3、C4水平明显低于常规治疗组（P均〈0．05），并呈现恢复延迟的特点，而血清IgA、IgG、IgM水平两组比较差异均无显著性（P均〉0．05）。强化治疗组患者治疗4d和6d单核细胞大肠杆菌吞噬能力比入院时显著增强，且2、4和6d的大肠杆菌FITC阳性率均显著高于常规治疗组（P均〈0．05）。结论胰岛素强化治疗能明显改善严重创伤后免疫功能，增强单核细胞噬菌能力，是提高患者机体抵抗力的有效方法之一。

Objective To investigate the influence of intensive insulin therapy on serum immunoglobulin （Ig）, complement levels and phagocytosis of monocytes in patients with severe trauma. Methods Severe injuried patients with injury severity score （ISS）〉 20 in surgical intensive care unit （ICU） were randomly divided into two groups, intensive insulin therapy and conventional therapy. Blood glucose levels in intensive insulin therapy and conventional therapy groups were maintained at 4 - 6 mmol/L and 〈11.1 mmol/L, respectively. Blood samples were obtained on 0, 2, 4, 6 and 8 days after admission. Dynamic changes of immunological parameters including serum IgA, IgG, IgM, complements （C3, C4） levels were determined in each group at various intervals following trauma. Phagocytosis of monocytes was also measured by use of phagotest kits after blood cells were incubated with fluorescin isothiocyanate （FITC）-labeled E. coli in a heated water bath at 37 ℃. Results Serum IgA, IgG, IgM, C3 and C4 levels were low in two groups at admission, and elevated after treatment with recovery to normal range on 6- 8 days. Serum C3 and C4 levels in intensive insulin therapy group were much lower than those in conventional therapy group （both P 〈 0.05） with delayed recovery to normal range. There were no significant differences in serum IgA, IgG and IgM levels between two groups （all P〉0.05）. For the patients with intensive insulin therapy, phagocytosis of monocytes was markedly enhanced on 4 and 6 days compared with those at admission （both P〈0.05）, and E. coli- FITC positive rates were significantly higher than those with conventional therapy on 2, 4 and 6 days after admission （all P〈0. 05）. Conclusion Intensive insulin therapy can markedly improve immune function and enhance phagocytosis of monocytes, which might be used as one of effective methods to increase the host defense ability in traumatic patients.