危重患儿血糖与胰岛素水平的临床分析

Clinical analysis of blood glucose and insulin levels in critically ill children

目的分析危重患儿血糖和胰岛素水平变化，探讨危重患儿高血糖发生相关机制。方法检测2007年1至12月我院PICU收治的51例危重患儿入院时血糖和胰岛素水平变化，并与15例健康体检儿检测结果进行对照分析。结果（1）各种基础疾病下的危重患儿入院24h内血糖均值均高于正常范围，以感染性休克组为最高[（11．35±6．21）mmol／L]；患儿入院5d内每日血糖均值波动情况以入院当天为最高，其后持续高于正常。（2）入院24h内肺部感染、颅内感染和感染性休克患儿血胰岛素水平分别为（17．65±16．85）mU／L、（13．45±7．33）mU／L、（16．24±12．41）mU／L，均高于对照组[（8．70±6．57）mU／L]，而先天性心脏病组[（6．75±3．22）mU／L]略低于正常组，但各组间差异无显著性（F=0．356，P=0．127）；入院当天和第3天、第5天患儿血胰岛素平均水平均高于正常对照组[（8．70±6．57）mU／L]；根据血糖水平，将患儿分为血糖正常组和高血糖组，两组血胰岛素水平分别为（5．44±3．38）mU／L、（14．22±12．29）mU／L，高血糖组胰岛素水平明显高于对照组。（3）患儿危重评分（PIMⅡ）均值为12．69±16．82，共死亡8例，病死率为15．6％；死亡患儿血糖和胰岛素水平均明显高于存活患儿（P〈0．05）。（4）血糖和血胰岛素水平间无明显线性关系；危重症评分和血胰岛素水平无线性相关性；血糖和危重症评分间线性相关性不显著。结论危重症患儿常出现高血糖和高胰岛素血症，两者在一定程度上间接反映疾病严重程度，也是判断预后的间接指标；高血糖与胰岛素相对不足或（和）胰岛素抵抗有关，至于其确切的关系需要进一步研究证实。

Objective To analyse the changes of blood glucose and insulin levels in children with critical illness, and to investigate the mechanism of hyperglycemia in critical illness. Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007, which were compared with those of 15 healthy children. Results （ 1 ） All the patients had hyperglycemia after admission within 24h, septic shock patients showed the highest level with the maximum value of 27. 30 mmol/L. The daily mean blood glucose levels of the first 5 days after admission peaked on the admission day. （2） Within 24 h after admission,the blood insulin levels of patients with pulmonary infection, intracranial infection,septic shock and congenital heart disease were （17. 65 ± 16.85 ） mU/L, （13.45 ± 7. 33 ） mU/L, （ 16. 24 ± 12.41 ） mU/L, （ 6. 75 ± 3.22） mU/L respectively. The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[ （8. 70 ±6. 57） mU/L]. According to blood glucose level on admission day, the patients were divided into normoglycemia and hyperglycemia group, and the blood insulin levels of the former and the latter were （ 5.44 ± 3.38 ） mU/L and （ 14. 22 ± 12. 29） mU/L respectively. （ 3 ） The mean of PIM Ⅱ score of the patients averaged 12. 96 ± 16. 82,and the mortality rate was 15.6%. The blood glucose level and the insulin level within 24 h after admission were （ 10. 97 ±5.76） mmoL/L and （49. 46 ±90. 35） mU/L in dead cases and （8. 73 ±2. 58） mmol/L and （ 11.91 ± 11.24） mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals（P 〈 0. 05 ）. （4） The scatter graphic analysis did not show significant linear relation between blood glucose and insulin, nor did it show significant linear relation between PIM Ⅱ and insulin tevei, or blood glucose. Conclusion Hyperglycemia and hyperinsulinemia are common in critical illness, which reflects indirectly the severity and prognosis of the disease. Hyperglycemia may be related to relative insulin insufficiency or insulin resistance; however, the definite relationship can not be con- firmed until more reliable clinical data were available in the future.