胰岛素强化治疗对严重烧创伤患者胰岛素抵抗的影响

Influence of intensive insulin therapy on insulin resistance of patients with severe burn or trauma

目的 探讨胰岛素强化治疗对严重烧（创）伤患者胰岛素抵抗的影响。方法 将重庆市第三人民医院和第三军医大学西南医院2010年1月—2011年12月收治的60例严重烧（创）伤患者，按随机配对分组法分为2组，每组30例：试验组给予胰岛素强化治疗，将血糖水平控制在6.0~8.0 mmol/L；对照组行常规治疗。治疗前及治疗后1、3、7、10、14 d检测患者空腹血糖、血浆胰岛素水平。采用稳态评估法计算胰岛素抵抗指数和胰岛β细胞功能指数。对数据进行t检验、方差分析及LSD检验。结果 治疗后1、3、7、10 d，试验组患者血糖水平分别为（6.8±1.4）、（6.7±1.3）、（5.8±1.9）、（5.4±1.6）mmol/L，明显低于对照组患者的（14.8±4.9）、（12.7±3.7）、（7.7±1.9）、（6.6±1.3）mmol/L，t值分别为12.453、11.386、5.563、4.731，P〈0.05或P〈0.01。治疗后3、7 d，试验组患者血浆胰岛素水平分别为（14±5）、（10±3）mU/L，明显低于对照组的（16±4）、（13±4）mU/L，t值分别为4.212、4.364，P值均小于0.05。除对照组治疗后3 d血糖水平外，2组患者治疗后各时相点血糖和胰岛素水平与治疗前比较，差异均有统计学意义（P值均小于0.01）。治疗后1、3、7、10 d，试验组患者胰岛素抵抗指数分别为1.60±0.80、1.46±0.70、0.96±0.21、0.90±0.23，显著低于对照组的2.15±1.35、2.21±1.21、1.50±0.95、1.17±0.66，t值分别为8.316、10.607、7.825、5.217，P〈0.05或P〈0.01。2组患者治疗后各时相点胰岛素抵抗指数均显著低于治疗前（P值均小于0.01）。治疗后1、3、7 d，试验组患者的胰岛β细胞功能指数分别为4.6±2.9、4.5±3.3、4.5±3.6，显著高于对照组的3.4±2.5、3.6±2.2、4.2±2.5，t值分别为8.243、7.914、4.338，P〈0.05或P〈0.01。2组中，仅对照组治疗后1、3 d胰岛β细胞功能指数显著低于治疗前（P值均小于0.05）。结论 胰岛素强化治疗可以减轻严重烧（创）伤患者伤后胰岛素抵抗。

ObjectiveTo discuss the influence of intensive insulin therapy on insulin resistance of patients with severe burn or trauma. Methods Sixty patients with severe burn or trauma hospitalized in the Third People′s Hospital of Chongqing or Southwest Hospital of the Third Military Medical University from January 2010 to December 2011 were randomly divided into intensive insulin therapy group （IT, treated with intensive insulin therapy to control the blood glucose to the level of 6.0-8.0 mmol/L） and control group （C, treated with routine therapy） according to the paired grouping method, with 30 patients in each group. Before treatment and on post treatment day （PTD） 1, 3, 7, 10, 14, the levels of fasting blood glucose and fasting plasma insulin were determined. Insulin resistance index and β-cell function index were calculated using homeostasis model assessment. Data were processed with t test, analysis of variance, and LSD test.ResultsOn PTD 1, 3, 7, 10, levels of fasting blood glucose in group IT [（6.8±1.4）, （6.7±1.3）, （5.8±1.9）, （5.4±1.6） mmol/L] were significantly lower than those of group C [（14.8±4.9）, （12.7±3.7）, （7.7±1.9）, （6.6±1.3） mmol/L, with t values respectively 12.453, 11.386, 5.563, 4.731, P〈0.05 or P〈0.01]. On PTD 3, 7, levels of fasting insulin in group IT [（14±5）, （10±3） mU/L] were significantly lower than those of group C [（16±4）, （13±4） mU/L, with t values respectively 4.212, 4.364, P values below 0.05]. Levels of fasting blood glucose and fasting insulin in the two groups at each time point were statistically significantly different from those before treatment （with P values below 0.01）, except for the level of fasting blood glucose on PTD 3. On PTD 1, 3, 7, 10, levels of insulin resistance index in group IT （1.60±0.80, 1.46±0.70, 0.96±0.21, 0.90±0.23） were significantly lower than those in group C （2.15±1.35, 2.21±1.21, 1.50±0.95, 1.17±0.66, with t values respectively 8.316, 10.607, 7.825, 5.217, P〈0.05 or P〈0.01）. Levels of insulin resistance index of patients in the two groups at each time point after treatment were significantly lower than those before treatment （with P values below 0.01）. On PTD 1, 3, 7, levels of β-cell function index in group IT （4.6±2.9, 4.5±3.3, 4.5±3.6） were significantly higher than those in group C （3.4±2.5, 3.6±2.2, 4.2±2.5, with t values respectively 8.243, 7.914, 4.338, P〈0.05 or P〈0.01）. Levels of β-cell function index in group C on PTD 1 and 3 were significantly lower than that before therapy （with P values below 0.05）. Conclusions Intensive insulin therapy can alleviate insulin resistance of patients with severe burn or trauma.