血糖控制水平对ICU重症感染患者hs-CRP、HMGB1、IL-6水平及预后的影响

Effects of blood glucose control level on hs-CRP,HMGB1 and IL-6 levels and prognosis in patients with severe ICU infection

目的探讨血糖控制水平对ICU重症感染患者超敏-C反应蛋白(hs-CRP)、高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)水平及预后的影响。方法选取2018年2月至2020年6月我院ICU收治的171例重症感染患者作为研究对象,采用随机数字表法将其分为Ⅰ组、Ⅱ组、Ⅲ组,每组57例。三组均采用静脉胰岛素泵入的方法控制血糖,Ⅰ组、Ⅱ组、Ⅲ组血糖水平分别控制在7.8~10.0、6.1~7.7、4.4~6.0 mmol/L。比较三组患者入住ICU第1、3、6天的WBC计数、乳酸(LAC)、hs-CRP、HMGB1、IL-6水平、APACHEⅡ评分及预后指标。结果入住ICU第1、3、6天,三组WBC计数、LAC水平无显著差异(P>0.05);入住ICU第6天,Ⅱ组、Ⅲ组APACHEⅡ评分均低于Ⅰ组(P<0.05)。入住ICU第1天,三组hs-CRP、HMGB1、IL-6水平无显著差异(P>0.05);入住ICU第3天,Ⅱ组、Ⅲ组hs-CRP水平均低于Ⅰ组,且Ⅲ组hs-CRP水平低于Ⅱ组(P<0.05);入住ICU第6天,Ⅱ组、Ⅲ组HMGB1、IL-6水平均低于Ⅰ组(P<0.05)。三组28 d病死率、MODS发生率无显著差异(P>0.05);Ⅰ组、Ⅲ组ICU住院时间均长于Ⅱ组(P<0.01);Ⅱ组、Ⅲ组抗生素应用时间均短于Ⅰ组(P<0.01);Ⅲ组低血糖发生率高于Ⅰ组(P<0.05)。结论将ICU重症感染患者的血糖水平控制在6.1~7.7 mmol/L,可有效降低血清hs-CRP、HMGB1及IL-6水平,减轻炎症反应,缩短ICU住院时间,改善患者预后。

Objective To investigate the effects of blood glucose control level on high sensitivity C-reactive protein(hs-CRP),high mobility group box 1(HMGB1),interleukin-6(IL-6)levels and prognosis in patients with severe ICU infection.Methods A total of 171 patients with severe ICU infection admitted in our hospital from February 2018 to June 2020 were selected as the research objects and divided into groupⅠ,groupⅡand groupⅢused random number table method,with 57 cases in each group.The blood glucose of the three groups was controlled by intravenous insulin pump,the groupⅠ,groupⅡand groupⅢblood glucose level were controlled at 7.8-10.0,6.1-7.7 and 4.4-6.0 mmol/L respectively.The WBC count,lactic acid(LAC),hs-CRP,HMGB1,IL-6 levels,APACHEⅡscore and prognosis indexes of the three groups were compared on the first,third and sixth day of ICU admission.Results There were no significant differences in WBC count and LAC level among the three groups on the first,third and sixth day of ICU admission(P>0.05);on the sixth day of ICU admission,APACHEⅡscore of the groupⅡand the groupⅢwere lower than that of the groupⅠ(P<0.05).There were no significant differences in the levels of hs-CRP,HMGB1 and IL-6 among the three groups on the first day of ICU admission(P>0.05);on the third day of ICU admission,the level of hs-CRP of the groupⅡand the groupⅢwere lower than that of the groupⅠ,and that of the groupⅢwas lower than the groupⅡ(P<0.05);on the sixth day of ICU admission,the level of HMGB1 and IL-6 of the groupⅡand the groupⅢwere lower than those of the groupⅠ(P<0.05).There were no significant differences in 28 d mortality and MODS incidence among the three groups(P>0.05);ICU hospitalization time of the groupⅠand the groupⅢwas longer than that of the groupⅡ(P<0.01);antibiotic application time of the groupⅡand the groupⅢwas shorter than that of the groupⅠ(P<0.01);the incidence of hypoglycemia of the groupⅢwas higher than that of the groupⅠ(P<0.05).Conclusion Controlling the blood glucose level of patients with severe ICU infection at 6.1-7.7 mmol/L can effectively reduce the serum hs-CRP,HMGB1 and IL-6 levels,reduce the inflammatory reaction,shorten the ICU hospitalization time and improve the prognosis of patients.