强化胰岛素治疗对产科重症病人CRP、IL-6、TNF-α的影响

Effects of intensive insulin therapy on immune factors of obstetrics patients with critical illness

目的探讨强化胰岛素治疗（intensive insulin therapy,IIT）对产科重症病人免疫因子的影响。方法将2005年1月至2007年12月42例收住重庆医科大学附属第一医院中心ICU的产科重症病人随机分为强化治疗组（目标血糖4.4~6.1mmol/L）,常规治疗组（目标血糖10.0~11.1mmol/L）。IIT治疗前、治疗后第1、3、5天测定血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）的动态变化。结果强化治疗组平均每日胰岛素用量更高（P〈0.05）。42例治疗前血清CRP、IL-6、TNF-α较正常水平均明显升高,且均与血糖水平呈正相关。IIT后,强化治疗组血清CRP在治疗后第5天为（40.92±14.46）mg/L,较常规治疗组（87.50±30.20）mg/L显著下降（P〈0.05）;血清IL-6在治疗后第5天为（28.76±6.62）ng/L,较常规治疗组（47.45±17.24）ng/L显著下降（P〈0.05）。TNF-α在治疗后第1天为（254.37±39.50）ng/L,较常规治疗组（325.17±29.47）ng/L开始下降（P〈0.05）,在治疗后第5天为（99.71±13.43）ng/L,较常规治疗组（254.73±19.43）ng/L显著下降（P〈0.05）。结论IIT对产科重症病人损伤后炎症反应有明显调节作用,有益于改善产科重症病人预后。

Objective To investigate the correlation of stress hyperglycemia with serum levels of C reactive protein（CRP）,interleukin-6（IL-6）and Tumor Necrosis Factor-α（TNF-α）in critical obstetrics patients and to explore the effect of IIT on these immune factors.Methods 42 critical obstetrics patients,who were admitted in the ICU of the first affiliated hospital of the chongqing medical university between January 2005 and December 2007,were randomly divided into the IIT group（maintenance blood glucose at a level between 4.4 and 6.1mmol/L）and routine therapy group（maintenance blood glucose at a level between 10.0 and 11.1mmol/L）.Levels of CRP,IL-6 and TNF-α were measured before the treatment and then measured again at 1,3 and 5d after treatment.Results In the routine therapy group,the serum levels of CRP,IL-6 and TNF-α in all cases were significantly increased and were positively correlated with the level of blood glucose.The CRP level of IIT group at 5 d after treatment was（40.92±14.46）mg/L which was significantly decreased compared with the level of routine therapy group which was（87.50±30.20）mg/L（P0.05）.The IL-6 level of IIT group at 5 d after treatment was（28.76±6.62）ng/L which was significantly decreased compared with the level of routine therapy group which was（47.45±17.24）ng/L（P0.05）.The TNF-α level of IIT group began to decrease to（254.37±39.50）ng/L at 1 d after treatment compared with the level of the routine therapy group which was（325.17±29.47）ng/L（P0.05）.Then the TNF-α level of IIT group was significantly decreased to（99.71±13.43）ng/L at 5 d after treatment compared with the level of routine therapy group which was（254.73±19.43）ng/L（P0.05）.Conclusion ＂Intensive insulin therapy＂ could obviously regulate the inflammatory reaction of post-injury by controlling glycemia within the normal level to inhibit excessive inflammatory reaction and have a good prognosis.