早期胰岛素强化治疗对严重烧伤患者胰岛素抵抗和胰岛β细胞功能的影响

Effects of Early Intensive Treatment with Insulin on Insulin Resistance and Beta Cell Function in Patients with Severe Burns

目的：探讨早期胰岛素强化治疗对严重烧伤患者胰岛素抵抗（insulin resistance,IR）和胰岛β细胞功能的影响。方法：将2010年1月—2013年6月收治的128例严重烧伤患者随机分为胰岛素持续皮下输注（continuous subcutaneous insulin infusion,CSII）组和对照组,各64例。CSII组给予胰岛素强化治疗,使空腹血糖（fasting blood glucose,FBG）控制在5～6.1mmol/L;对照组行常规治疗。治疗前及治疗后1、3、7、14 d检测FBG、空腹胰岛素（fasting insulin,FINS）水平。使用稳态模式评估法（homeostasis model assessment,HOMA）计算IR指数（HOMR IR index,HOMA-IR）和胰岛β细胞功能指数（HOMA beta cell function index,HBCI）。结果：治疗后1、3、7 d,CSII组FBG水平明显低于对照组（P〈0.05）。治疗后3、7 d,CSII组FINS水平均明显低于对照组（P〈0.05）;除对照组治疗后3 d FBG水平外,2组患者治疗后各时间点FBG和FINS水平与治疗前比较,差异均有统计学意义（P〈0.01）。治疗后1、3、7 d,CSII组HOMA-IR均显著低于对照组（P〈0.01）,2组患者治疗后各时间点HOMA-IR均低于治疗前（P〈0.01）。治疗后1、3、7 d,CSII组HBCI均显著高于对照组（P〈0.01）,对照组治疗后1、3 d HBCI均低于治疗前（P〈0.05）。结论：早期胰岛素强化治疗可减轻严重烧伤患者烧伤后高血糖、高胰岛素血症,有利于恢复胰岛β细胞功能,改善愈后。

Objective：To explore the effect of early intensive treatment with insulin on insulin resistance（IR）and beta cell function in patients with severe burns.Methods：A total of 128 patients with severe burns from Jan 2010 to Jun 2013 were randomly divided into continuous subcutaneous insulin infusion（CSII）group and control group,with64 patients in each group.The CSII group received intensive treatment with insulin and the fasting blood glucose（FBG）was controlled within 5-6.1mmol/L.While the control group received the conventional treatment.FBG and fasting insulin（FINS）was tested before the treatment and at 1 d,3 d,7 d and 14 d after the treatment.Homeostasis model assessment（HOMA）was used to calculate the IR index（HOMA-IR）and HOMA beta cell function index（HBCI）.Results：At 1 d,3 d,7 d after the treatment,the level of FBG in the CSII group was significantly lower than that in the control group（P〈0.05）.At 3 d and 7 d after the treatment,the level of FINS in the CSII group was significantly lower than that in the control group（P〈0.05）.Except for FBG in the control group at 3 d after the treatment,both groups had differences in FBG and FINS at each time point after the treatment compared with that before the treatment（P〈0.01）.At 1 d,3 d,7 d after the treatment,HOMA-IR in the CSII group was significantly lower than that in the control group（P〈0.01）,and both groups had differences in HOMA-IR at each time point after treatment compared with that before the treatment（P〈0.01）.At 1 d,3 d,7 d after treatment,HBCI in the CSII group was significantly higher than that in the control group（P〈0.01）,and HBCI in the control group at 1 d and 3 d after treatment was lower than that before treatment（P〈0.05）.Conclusions：Early intensive treatment with insulin can effectively reduce hyperglycemia,hyperinsulinemia after the burning and stablize beta cell function.