内科危重病患者胰岛素抵抗相关因素研究

Study of related factors of insulin-resistance in medical critically ill patients

目的目的通过观察危重病患者早期血糖、胰岛素浓度及胰岛素抵抗(IR)的变化,这些指标与疾病。方法选取本院ICU内科危重病患者52例,于入院24h内进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,次日清晨抽取空腹静脉血测血糖(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)。52例中入ICU28d后仍存活者划入存活组,余为死亡组。另选择健康体检者30人为对照组,检测FBG、FINS及计算HO-MA-IR。结果内科危重病组FBG、FINS浓度及HOMA-IR均高于对照组(P均<0.01)。死亡组FBG浓度、HOMA-IR及A-PACHEⅡ评分均高于存活组(P<0.05);而FINS浓度两组比较差异无统计学意义。按APACHEⅡ评分分值≤10分、11～20分、≥21分3组,表现为随评分增加,各组FBG、FINS均显著增加(P<0.05)。结论危重病应激状态下存在胰岛素抵抗。FBG及HOMA-IR可反映危重病严重程度及预后,部分患者表现为高胰岛素血症,但FINS不能准确反映危重病的病情及预后。

Objective To observe the changes of blood glucose,serum insulin level and insulin resistance （IR） of medical critically ill patients in the early course of critical illness and to explore the relationship between the changes of parameters, severity of illness and prognosis. Methods 52 patients in intensive care unit （ICU） were enrolled. All the patients were assessed with acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ ） scores in 24 hours after admission. Fasting blood glucose （FBG） and fast- ing insulin （FINS） were determined within 24 hours or the next rooming, Insulin resistance index （HOMA-IR） was calculated by u- sing Homeostasis Model Assessment （HOMA）. Of the 52 patients who were alive after 28 days were put under survivor group,the rest were put under death group. 30 health volunteers were as control group and test FBG, FINS and D HOMA-IR. Results The levels of FBG, FINS AND HOMA-IR in medical critically ill patients were significantly higher than those in normal control group （ all P 〈 0. 01 ）. FBG,HOMA-IR and APACHE Ⅱ scores in the death group were significantly higher than those in the survivor group （P 〈 0.05） ,but no difference in FINS levels was found between the two groups. Based on APACHE Ⅱ scores, the patients were divided into group I （APACHE Ⅱ scores ≤10） , Ⅱ （ APACHE Ⅱ seores11 - 20 ） ,Ⅲ （ APACHE Ⅱ scores ≥ 21 ）. The levels of FBG and FINS were found to be elevated with the increase in APACHE Ⅱ scores（P 〈 0.05）. Conclusion The study suggests that FBG and HOMA-IR could be used to evaluate the severity and prognosis. Hyperinsulinemia is found in some critically ill patients,but FINS is not helpful for assessing the severity and outcome.