短期胰岛素强化治疗对围手术期高血糖患者胰岛β细胞功能的影响

Effects of short-term intensive insulin therapy in patients with hyperglycemia on beta cell function in perioperative period

目的探讨短期胰岛素强化治疗对围手术期高血糖患者β细胞功能的影响。方法回顾性分析2011年1月~2013年7月我院短期胰岛素强化治疗围手术期高血糖的患者临床资料,其中采用持续性皮下胰岛素输注治疗患者25例（CSII组）,采用多次皮下胰岛素注射治疗患者20例（MSII组）。治疗2周后,比较两组的血糖控制（FBG、2h PG、GSP）、β细胞功能、胰岛素敏感性指标以及TNF-α、IL-1β、CRP、APN的变化情况。结果 CSII组与MSII组的FBG、2h PG、GSP水平均较治疗前显著降低,差异具有统计学意义（P〈0.05）;治疗后CSII组的FBG、2h PG、GSP水平与MSII组比较,差异不显著（P〉0.05）。CSII组与MSII组的GSP、Homa-IR水平均较治疗前显著降低,Homa-β较治疗前显著升高,且与MSII组比较改善更显著（P〈0.05）;同样CSII组TNF-α、IL-1β、CRP水平与MSII组比较也改善更显著（P〈0.05）。结论持续性皮下胰岛素输注治疗可有效控制血糖,显著改善胰岛β功能及提高胰岛素敏感性,其机制可能与下调炎性因子有关。

Objective To explore the effect of short-term intensive insulin therapy in patients with hyperglycemia on beta cell function in perioperative period. Methods From January 2011 to July2013 in our hospital, forty-five patients in perioperative period with hyperglycemia were underwent short-term intensive therapy（continuous subcutaneous insulin infusion, CSII group, n =25; multiple subcutaneous insulin injection, MSII group, n =20）. The data of FBG, 2h PG, blood glucose GSP,beta cell function and insulin sensitivity index and the changes of TNF- α, IL-1β, CRP and APN were compared between the two groups. Results After the treatment, the patients of CSII group and MSII group showed significantly decreased FBG, 2h PG and GSP levels（P〈0.05）. Both CSII group and MSII group showed significantly lower FCP and Homa-IR levels, and higher Homa-β after treatment（P〈0.05）. CSII group demonstrated more significantly improvement compared with MSII（P〈0.05）. And the same changes of TNF-α, IL-1β, CRP, and APN levels were observed after treatment in CSII group compared with MSII group. Conclusion The continuous subcutaneous insulin therapy can effectively control blood glucose and improve islet function and insulin sensitivity,which is involved by reducing inflammation.