胰岛素强化治疗对脓毒症患者血清超敏C反应蛋白、肿瘤坏死因子-α和白介素-6水平的影响及疗效观察

Influence and Curative Effect Observation of Intensive Insulin on Serum High-Sensitivity C-Reactive Protein,Tumor Necrosis Factor-α and Interleukin-6 Levels of Patients with Metastasizing Septicemia

目的：探讨胰岛素强化治疗对脓毒症患者血清超敏C反应蛋白（hs-CRP）、肿瘤坏死因子（TNF）-α和白介素（IL）-6水平的影响及疗效观察。方法：脓毒症患者74例随机分为强化组（37例）和常规组（37例）。两组患者均予常规治疗。强化组患者入院次日予胰岛素持续泵入,控制血糖4.4～6.1 mmol·L-1;常规组患者入院次日常规使用胰岛素治疗,控制血糖10.0～11.9 mmol·L-1。观察两组患者治疗前和治疗7 d后血hs-CRP、TNF-α和IL-6水平变化,并比较两组治疗期间普通胰岛素用量、临床疗效及药品不良反应。结果：治疗7 d后,两组患者血清hs-CRP、TNF-α和IL-6水平均有不同程度的下降（P〈0.01或0.05）,且强化组下降幅度明显大于常规组（P〈0.05）。强化组临床总有效率为94.59%,明显高于常规组的75.68%（P〈0.05）,强化组普通胰岛素平均用量明显高于常规组（P〈0.05）。两组患者不良反应发生率比较,差异无统计学意义（P〉0.05）。结论：胰岛素早期强化治疗脓毒症患者疗效肯定,能明显降低血清hs-CRP、TNF-α和IL-6水平的影响,可更好地抑制机体炎症反应,改善患者的预后。

Objective： To discuss influence and curative effect observation of intensive insulin on serum high-sensitivity C-reactive protein（ hs-CRP）,tumor necrosis factor-α（ TNF-α） and interleukin-6（ IL-6） levels of patients with metastasizing septicemia. Methods： 74 cases of patients with metastasizing septicemia were divided into intensive group（ n= 37） and routine group（ n = 37） at random. The patients in two groups were given routine medical treatment,such as anti-infection,nutrition support,maintenance of water and electrolyte acid-base balance,vasoactive agent,treatment of basic diseases and etc. The patients in intensive group were given insulin by pumping constantly from the second day after admission,and the blood sugar was controlled between 4. 4-6. 1 mmol·L- 1. The patients in routine group were given insulin as conventional therapy from the second day after admission,and the blood sugar was controlled between 10. 0-11. 9 mmol·L- 1. The changes of hs-CRP,TNF-α and IL-6 levels of patients in two groups before and 7 days after the medical treatment were observed,and use level of regular insulin,the clinical curative effect and adverse drug reactions was compared as well.Results： After 7 days＇ medical treatment,the hs-CRP,TNF-α and IL-6 levels of patients in two groups declined with different degrees（ P〈0. 01 or P〈0. 05）,and the declining rate in intensive group was much higher than that in routine group（ P〈0. 05）. Meanwhile,the total clinical efficiency of patients in intensive group（ 94. 59%） was much higher than that in routine group（ P〈0. 05）,the use level of regular insulin in intensive group was much higher than that in routine group（ P〈0. 05）,and no differences were appeared of adverse drug reactions in two groups（ P〈0. 05）. Conclusion： The application of intensive insulin has reliable curative effect on patients with metastasizing septicemia at early stage,which can obviously reduce the influence of serum hs-CRP,TNF-α and IL-6 levels,inhibit the inflammatory reaction of body successfully and improve the prognosis of patients.