内科危重病患者胰岛素抵抗的变化及临床意义

Changes of insulin resistance and its clinical significance in critically ill medical patients

目的 通过观察内科危重病患者入ICU后早期血糖、胰岛素浓度以及胰岛素抵抗（IR）的变化，探讨这些指标与疾病的严重程度和预后的关系。方法选取本院ICU内科危重病患者50例和正常对照20例，24h内或次日清晨抽取空腹静脉血检测空腹血糖（FBG）和胰岛素（FINS）浓度，使用稳态模式法（HOMA）计算胰岛素抵抗指数（HOMA—IR）。结果内科危重病组FBG、FINS浓度及HOMA—IR均显著高于对照组（P均〈0．001）。死亡组FBG浓度、HOMA—IR及APACHEⅡ评分均显著高于存活组（P〈0．001或P〈0．05）；而FINS浓度两组比较差异无统计学意义。内科危重病不同病种间FBG、FINS浓度、HOMA—IR和APACHEⅡ评分比较差异均无统计学意义（P均〉0．05）。APACHEⅡ评分与FBG浓度、HOMA—IR呈显著正相关（FBGr=0．500，P〈0．001；HOMA—IRr=0．320，P〈0．05）；APACHEⅡ评分与FINS浓度相关不显著（r=-0．107，P〉0．05）。结论内科危重病患者早期出现IR，与疾病的种类无关。FBG浓度和HOMA—IR可以用于判断内科危重病患者病情的严重程度及评估预后。

Objective To observe the changes of blood glucose, serum insulin level and insulin resistance （ IR ） of critically ill medical patients in the early course of critical illness and to explore the relationship between the changes of parameters, severity of illness and prognosis. Methods 50 critically ill medical patients in intensive care unit （ ICU ） and 20 healthy volunteers serving as normal controls were enrolled. Fasting blood glucose （ FBG ） and fasting insulin （ FINS ） were determined within 24 hours or the next morning. Insulin resistance index （ HOMA - IR ） was calculated by using Homeostasis Model Assessment （ HOMA ）. Results The levels of FBG, FINS and HOMA - IR in critically ill medical patients were significantly higher than those in normal controls（ all P 〈 0. 001 ）. FBG, HOMA - IR and APACHE Ⅱ scores in the dead were significantly higher than those in the survivors （ P 〈 0. 001 or P 〈 0. 05 ）, but no difference in FINS levels was found between the two groups. There were no significant changes in FBG, FINS, HOMA - IR and APACHE Ⅱ scores among different diseases （ all P 〉 0.05）. FBG and HOMA - IR were all significantly and positively correlated with APACHE Ⅱ scores （ FBG r = 0. 500,P 〈 0. 001 ; HOMA - IR r = 0. 320,P 〈 0. 05 ）, while FINS was not （ r = - 0. 107, P 〉 0. 05 ）. Conclusion IR was found in critically ill medical patients in the early course of critical illness . The severity of IR did not vary among patients with different admission diagnosis. FBG and HOMA - IR can be used to evaluate the severity of disease and predict the prognosis in critically ill medical patients.