强化胰岛素治疗对严重创伤患者淋巴细胞亚群水平及预后的影响

Effects of intensive insulin therapy on peripheral T-lymphocyte subpopulations and prognosis in patients with severe trauma

目的探讨强化胰岛素治疗对严重创伤患者淋巴细胞亚群动态变化和对预后的影响。方法对收治的56例严重创伤患者随机分为强化胰岛素治疗组(A组,控制血糖在4.4～6.1mmol/L)和常规治疗组(B组,控制血糖在10.0～11.1mmol/L),观察两组患者治疗前后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 A组与B组比较,外周血CD3+、CD4+、CD4+/CD8+比值治疗第1、3天水平较低,第1天两组比较,差异均无统计学意义(t分别=1.14、0.74、0.60,P均>0.05),治疗后逐渐开始升高。两组患者于治疗第3、7、14天,A组CD3+、CD4+、CD4+/CD8+比值大于B组,上升速度快于B组,两组比较,差异均有统计学意义(t分别=2.69、3.31、2.37;2.73、3.93、4.27;3.40、5.71、10.68,P均<0.05)。两组各时段的CD8+比较,除第3天差异有统计学意义外(t=2.31,P<0.05),其余时段比较,差异均无统计学意义(t分别=1.24、0.95、0.48,P均>0.05)。A组合计并发症发生率和病死率均低于B组,差异均有统计学意义(χ2分别=5.91、4.88,P均<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 investigate the influence of the alteration of intensive insulin therapy（IIT） on serum peripheral T-lymphocyte subpopulations and prognosis in patients with severe trauma.Methods A total of 56 patients with severe trauma were randomly divided into 2 groups.Intensive insulin therapy group was treated with tight control of blood glucose by intensive insulin therapy（group A,maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L）,and the other one was treated with conventional treatment（group B,maintenance of blood glucose at a level between 10.0 and 11.1 mmol/L）.Serum peripheral T-lymphocyte subpopulations were measured before and after therapy in each group.The incidence rate of complication and mortality were recorded.Results There was no significant difference in the ratios of CD3＋,CD4＋,CD4＋/CD8＋ between group A and group B on day 1（t=1.14,0.74,0.60,P0.05）.The ratios of the peripheral T-lymphocyte subpopulations were low on day 1 and day 3,then were elevated after treatment in two groups.The ratios and the rate of ascend of CD3＋,CD4＋,CD4＋/CD8＋ in group A were higher and faster than that in group B on day 3,7,14（t=2.69,3.31,2.37;2.73,3.93,4.27;3.40,5.71,10.68,P0.05）.There was no significant difference in the ratios of CD8＋ between two groups on day 1,7,14（t=1.24,0.95,0.48,P0.05）,except on day 3（t=2.31,P0.05）.There was significant different in the incidence rate of complication and mortality between group A and B（χ2=5.91,4.88,P0.05）.Conclusions Tight control of blood glucose by IIT can reduce the incidence rate of complication and mortality in severe traumatic patients;besides,T-lymphocyte subpopulations can be used as the indicators of the severity and prognosis.