胰岛素强化治疗高血糖危重症的中医学研究

Therapeutic Effect of Intensive Insulin Therapy on Critical Hyperglycemia Cases with Different Traditional Chinese Medical Syndromes

目的:观察胰岛素强化治疗高血糖危重症的疗效与中医证型及白细胞介素(IL)-6水平的关系。方法:将高血糖危重症[危重症病情评分系统(APACHE)Ⅱ评分达标]患者50例,随机分为强化组30例(血糖维持在4.4～6.1mmol/L)和常规组20例(血糖维持在10.0～11.1mmol/L),并于入院后治疗前、治疗后第1天、第5天和第10天测定血清IL-6值(ELISA法),观察中医辨证分型与患者死亡率、IL-6的关系。结果:强化组治疗后第1天、第5天和第10天血清IL-6表达显著低于常规组(P<0.05)。治疗前后各证型IL-6比较,差异均有非常显著性意义(P<0.01)。各证型间IL-6比较,差异有显著性意义(P<0.05)。实热证、气滞血瘀证与其他证型比较,差异均有显著性意义(P<0.05),实热证最低,气滞血瘀证最高。治疗后强化组有1例气滞血瘀证及1例腑气不通证患者死亡,常规组有2例气滞血瘀证、1例腑气不通证及1例厥脱证患者死亡。治疗后2组各证型APACHEⅡ评分比较,差异有显著性意义(P<0.05)。实热证、气滞血瘀证与其他证型比较,差异均有显著性意义(P<0.05),实热证最低,气滞血瘀证最高。结论:胰岛素强化治疗疗效与中医证型及IL-6水平相关。

Objective： To investigate the relationship of curative effect of intensive insulin therapy with traditional Chinese medical syndromes and interleukin 6 （IL-6） levels in critical hyperglycemia cases. Meth- ods= The critical hyperglycemia cases with APACHE II scores were allocated randomly to two groups. Thirty patients with 4.4- 6.1mmol/L blood glucose were enrolled in treatment group and received intensive insulin therapy, and 20 cases with 10.0 - 11.1mmol/L blood glucose were enrolled in control group and re- ceived conventional therapy. Serum IL-6 level was detected by ELISA before treatment, and on day 1, 5 and 10 after treatment. The relation of syndrome patterns with mortality and IL-6 level was investigated. Results： On day 1, 5 and 10 after treatment, serum IL-6 expression level in the treatment group was lower than that in the control group（P〈0.05）. Serum IL-6 expression level in both group after treatment differed from that before treatment（P〈 0.01）. The difference of IL-6 level in excessive heat syndrome and qi stagnation and blood stasis syndrome was significant （P 〈0.05 compared with the other syndromes）. Excessive heat syndrome had the lowest IL-6 level, and qi stagnation and blood stasis syndrome had the highest IL-6 level. In the treatment group, death occurred in one patient with qi stagnation and blood sta- sis syndrome , and in one patient with fu-organ qi obstruction syndrome. In the control group, death oc- curred in two patients with qi stagnation and blood stasis syndrome, in one patient with fu-organ qi obstruction syndrome, and in one patient with syncope-collapse syndrome. Conclusion： The curative effect of intensive insulin therapy on critical hyperglycemia cases is correlated with their syndrome patterns and serum IL-6 level.