强化胰岛素治疗对严重创伤患者降钙素原及淋巴细胞亚群的影响

Effect of intensive insulin therapy on serum procalcitonin and peripheral T-lymphocyte subsets in patients with severe injury

目的探讨强化胰岛素治疗对严重创伤患者血清降钙素原及淋巴细胞亚群的影响。方法前瞻性地对2008年1月至2011年1月宁波第二医院收治的56例严重创伤患者的临床资料进行收集、分析;把患者分为强化胰岛素治疗组(控制血糖在4.4～6.1mmol/L,A组)和常规治疗组(控制血糖在10.0～11.1mmol/L,B组),观察两组患者治疗前后降钙素原(PCT)、外周血淋巴细胞亚群水平以及并发症发生率和死亡率。结果两组患者治疗前性别、年龄、创伤严重程度评分、治疗前APACHEⅡ评分、PCT和淋巴细胞亚群水平差异无统计学意义(P>0.05)。两组患者治疗后第3天血PCT达到峰值并逐渐下降;治疗第3、5、7、10、14天,A组PCT的浓度低于B组,A组PCT的衰减速度快于B组,两组比较差异均有统计学意义(P均<0.05)。两组患者外周血CD3+、CD4+、CD4+/CD8+比值治疗第1、3天水平较低,治疗后逐渐开始升高。两组患者治疗第3、7、14天,A组CD3+、CD4+、CD4+/CD8+比值大于B组,且升高速度快于B组,两组比较差异均有统计学意义(P均<0.05)。A组的并发症发生率和死亡率均低于B组,差异有统计学意义(P<0.05)。结论强化胰岛素治疗严重创伤患者可降低并发症发生率和死亡率;同时PCT和淋巴细胞亚群水平检测可以作为其治疗过程中疾病严重程度及预后的指标。

Objective To assess the effects of intensive insulin therapy （IIT） on serum procalcitonin （PCT） and peripheral T-lymphocyte subsets in patients with severe injury. Methods A total of 56 patients with severe injury in the Second Hospital of Ningbo from Jan. 2008 to Jan. 2011 were enrolled in this prospective study. The patients were randomly divided into two groups, group A （32 cases） and group B （24 cases）. Patients in the group A were treated with intensive insulin therapy （blood glucose maintained between 4.4 and 6.1 retool/L）, while group B with conventional treatment （blood glucose maintained between 10.0 and 11.1 mmol/L）. Serum PCT and peripheral T-lymphocyte subpopulations were measured before and after therapy in each group. The incidence rates of complications and mortality were recorded. Results There were no significant differences in sex, age, Injury Severity Score, acute physiology and chronic health evaluation . scores, the levels of PCT and the ratios of peripheral T-lymphocyte subsets between the two groups before treatment （all P〉0.05）. The PCT levels reached to peak on the 3rd d after treatment, and then gradually reduced in the two groups. The PCT level in the group A were significantly lower than group B on days 3, 5, 7, 10, and 14 after treatment （all P〈0.05）. At the same time, the decay rate of PCT in group A was faster than group B （P〈0.05）. The ratios of the peripheral T-lymphocyte subsets were low on the 1st and 3rd d and then were gradually elevated after treatment in the two groups. The ratios of CD3＋,CD4＋,CDa＋/CDs＋ in group A were higher and increased faster than group B on days 3, 7, and 14 （all P〈0.05）. The incidence rates of complications and mortality showed significant difference between the two groups （all P〈0.05）. Condusions Tight control of blood glucose by lit can reduce the incidence rate of complication and mortality in severe traumatic patients. Moreover, levels of PCT and T-lymphocyte subpopulations can be used as the indicators of the severity and prognosis.