血胰岛素和C肽水平与严重多发伤炎症反应的关系

Relationship of serum insulin and peptide C levels with inflammatory reaction in patients with severe multiple trauma

目的探讨严重多发伤患者血胰岛素和C肽水平的变化及其与炎症反应的关系。方法检测30例严重多发伤患者伤后第1，3，7天的血胰岛素、C肽、TNF-α、IL-10、C反应蛋白（CRP），分析伤后血胰岛素和C肽的动态变化情况及其与急性生理和慢性健康评分Ⅲ（APACHEm）、炎症因子和CRP的相关性，并与炎症因子和CRP的变化进行比较。同时检测35例健康体检者的血胰岛素和c肽作为对照。结果患者伤后各时相点血胰岛素和C肽均显著高于对照组；与APACHEⅢ均呈显著正相关。无论是否控制血糖和年龄因素，血胰岛素和C肽与IL-10在各时相点均呈显著正相关，与TNF-α和CRP在伤后第3，7天呈显著正相关。在不同预后两组中血胰岛素、C肽、IL-10水平随时问变化均下降；TNF-α和CRP水平在生存组中均呈下降趋势，但死亡组随时间变化均升高；以上指标在相同时相点死亡组均显著高于生存组。结论严重多发伤后血胰岛素和C肽水平的升高与炎症反应有关，其变化不仅可以反映损伤严重程度，而且可以作为动态监测机体抗炎程度的有效参考指标。

Objective To approach the changes of serum insulin and peptide C and determine their relationship with inflammatory reaction in patients with severe multiple trauma. Methods The serum insulin, peptide C, tumor necrosis factor （TNF）-α, interleukin （IL）-10, C reactive protein （CRP） were detected in 30 patients with severe multiple trauma at clays 1,3 and 7 after trauma to analyze the dynamic changes of serum insulin and peptide C and their correlations with Acute Physiology and Chronic Health Evaluation Ⅲ （APACHE Ⅲ ）, cytokines and CRP. The changes of cytokines and CRP were also compared with those of serum insulin and peptide C in patients with different outcomes. The changes of serum insulin and peptide C of 35 healthy subjects were detected and used as control. Results The serum insulin and peptide C levels of patients were higher than those in control group at each time point after trauma, with remarkably positive correlation with APACHE Ⅲ. Whether the serum glu- cose and age were controlled or not ,serum insulin and peptide C were positively correlated with IL-10 at each time point and with TNF-α and CRP at days 3 and 7. The levels of serum insulin, peptide C and IL- 10 were decreased with time in both groups with different outcomes. Meanwhile, the levels of TNF-α and CRP were decreased in the survival groups but increased in the death groups. The levels of above indices in death group were significantly higher than survival groups at the same time point. Conclusions The increasing of serum insulin and peptide C is correlated with inflammatory reaction after severe multiple trauma. The dynamic changes of both indices can either reflect injury severity or be used as an effective index in dynamically monitoring anti-inflammatory degree of the organism.