严重烧伤患者胰岛素抵抗的动态变化

The variation of insulin resistance in burned patients

目的通过研究严重烧伤患者烧伤全身炎症反应综合征时胰岛素抵抗的相关指标(空腹血糖、空腹胰岛素、胰高血糖素)水平变化,探讨烧伤患者血清胰岛素抵抗的变化规律。方法 按住院先后顺序随机选取烧伤总面积符合入选标准的烧伤患者30例作为实验组,同时选取健康正常人17例作为对照组。实验组于烧伤后1d、3d、7d、4d四个时相点清晨空腹外周静脉采血,一份行FBG,血常规检测,同时另一份血样测定FINS,胰岛素抗体,C肽,Gl。使用稳态模式法(HOMA)计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)和胰岛素敏感指数(ISI)。结果 实验组胰岛素抵抗相关指数对照结果显示四个时相点测定均值与对照组有显著性差异(P<0.01)。实验组中度组、重度组、特重度组三组分别与对照组做PCT和IR相关指数对照,结果显示实验组的三个组伤后四个时相点测定均值均高于对照组(P<0.01);特重度组与中度组对照有部分指标显示明显差异(P<0.01)。结论 烧伤患者在烧伤休克期及烧伤感染期的早期都存在不同程度的IR。烧伤严重程度与胰岛素抵抗的程度有一定相关性,烧伤越严重,其胰岛素抵抗的程度就越重。

Objective B investigate the changes of the related indexes of the insulin resistance（FBG,FINS and GL） to explore the variation of insulin resistance in burned patients.Methods In accordance with their admission sequence and the requirement of TBSA,30 cases burned patients were chosen at random as experimental group.At the same time,17 normal adults were selected as control group.With the approval of patients,the blood samples were collected from the periphery vein in the morning of day 1、 day 3,day 7,day 14 post-burned.One blood sample was used to detect blood routine and FBG and another blood sample was used to detect FINS,INS-AB,C-peptide and GL.Meanwhile,the indexes of HOMA-IR,HOMA-β and ISI were calculated by the way of HOMA.Results The related indexes of the insulin resistance of the experimental group were obvious different from those of control group（P0.01）;The results indicated that the average values in experimental group at four time phases after burn were higher than those in the control group（P0.01）;and the obvious differences in part of indexes were revealed between some extremely severe degree and some moderate degree burned patients（P0.01）.Conclusion The insulin resistance can be observed in shock and infection stages of burned patients.The degree of burn presents the close correlation with the degree of insulin resistance.The more serious the degree of burn tends to be,the higher the insulin resistance may turn to be.