强化胰岛素治疗对脓毒症患者血管内皮细胞功能的影响
강화이도소치료대농독증환자혈관내피세포공능적영향
Effects of intensive insulin therapy on the functions of vascular endothelial cells in septic patients.
  • 万方数据
    中国综合临床 중국종합림상
    CLINICAL MEDICINE OF CHINA
    2010年 9期 907-911 ,共5页

    曹淼英%茅尧生%郑建鹏

    조묘영%모요생%정건붕

    脓毒症%强化胰岛素治疗%内皮细胞 膿毒癥%彊化胰島素治療%內皮細胞
    농독증%강화이도소치료%내피세포
    Sepsis%Intensive insulin therapy%Endothelial cell
    目的 研究强化胰岛紊治疗(IIT)对脓毒症患者血管内皮细胞(VEC)功能的影响.方法 将120例脓毒症患者随机分为强化胰岛素治疗1组(IIT1组)、强化胰岛素治疗2组(IIT2组)及常规胰岛素治疗组(CIT组),在治疗前及治疗后3、7 d用酶联免疫吸附双抗体夹心法(ELISA)检测3组患者各时相点血清血管性假血友病因子(vWF)、血栓调节蛋白(TM)、内皮素-1(ET-1)和一氧化氮(NO)的含量.同时观察3组患者28 d病死率、ICU住院时间、机械通气时间、△APACHEⅡ评分和△MODS评分.结果 相对于CIT组患者,IIT1与IIT2组患者血清的vWF、TM和ET-1明显降低[CIT、IIT1与IIT2组vWF分别为:治疗后3 d(142.57±10.07)%、(137.32±9.66)%、(138.32±8.80)%,治疗后7 d(126.27±10.49)%、(116.55±9.36)%、(120.72±9.53)%;TM:治疗后3 d(6.87±1.62)、(5.95±1.60)、(6.17±1.33)μg/L,治疗后7 d(4.55±1.48)、(3.35±0.94)、(3.87±1.20)μg/L;ET-1:治疗后3 d(61.27±9.20)、(55.97±9.03)、(57.37±7.70)ng/L,治疗后7 d(43.12±6.17)、(33.77±6.20)、(35.95±5.73)ng/L;P均＜0.05]、NO明显升高[治疗后3 d(37.77±8.17)、(42.75±9.92)、(41.80±8.66)p-mol/L,治疗后7 d(54.42±8.46)、(64.90±9.63)、(61.20±8.84)pmol/L;P均＜0.05],但两个亚组之间无明显差异(P＞0.05);同时,CIT、IIT1与IIT2 3组患者28 d病死率(分别为20.0%、12.5%、45.0%,χ2=8.82)、ICU住院时间[分别为(9.50±3.70)、(7.72±3.29)、(8.02±2.90)d,F值为3.28]、机械通气时间[分别为(8.92±3.79)、(7.23±3.32)、(7.37±2.99)d,F值为3.09]、△APACHEⅡ评分[分别为8.87±3.46、7.20±2.81、7.42±3.18,F值为3.30]和△MODS评分[分别为4.15±2.15、3.20±1.48、3.32±1.74,F值为3.23]差异具有统计学意义(P均＜0.05),且IIT1、IIT2组与CIT组比较,差异均有统计学意义(P均＜0.05),但两个亚组之间差异无统计学意义(P＞0.05).结论 IIT对脓毒症患者VEC具有保护作用,且将血糖控制在6.6～8.3mmol/L可以明显降低低血糖的发生率,同时IIT可以明显改善脓毒症患者的价值.
    목적 연구강화이도문치료(IIT)대농독증환자혈관내피세포(VEC)공능적영향.방법 장120례농독증환자수궤분위강화이도소치료1조(IIT1조)、강화이도소치료2조(IIT2조)급상규이도소치료조(CIT조),재치료전급치료후3、7 d용매련면역흡부쌍항체협심법(ELISA)검측3조환자각시상점혈청혈관성가혈우병인자(vWF)、혈전조절단백(TM)、내피소-1(ET-1)화일양화담(NO)적함량.동시관찰3조환자28 d병사솔、ICU주원시간、궤계통기시간、△APACHEⅡ평분화△MODS평분.결과 상대우CIT조환자,IIT1여IIT2조환자혈청적vWF、TM화ET-1명현강저[CIT、IIT1여IIT2조vWF분별위:치료후3 d(142.57±10.07)%、(137.32±9.66)%、(138.32±8.80)%,치료후7 d(126.27±10.49)%、(116.55±9.36)%、(120.72±9.53)%;TM:치료후3 d(6.87±1.62)、(5.95±1.60)、(6.17±1.33)μg/L,치료후7 d(4.55±1.48)、(3.35±0.94)、(3.87±1.20)μg/L;ET-1:치료후3 d(61.27±9.20)、(55.97±9.03)、(57.37±7.70)ng/L,치료후7 d(43.12±6.17)、(33.77±6.20)、(35.95±5.73)ng/L;P균＜0.05]、NO명현승고[치료후3 d(37.77±8.17)、(42.75±9.92)、(41.80±8.66)p-mol/L,치료후7 d(54.42±8.46)、(64.90±9.63)、(61.20±8.84)pmol/L;P균＜0.05],단량개아조지간무명현차이(P＞0.05);동시,CIT、IIT1여IIT2 3조환자28 d병사솔(분별위20.0%、12.5%、45.0%,χ2=8.82)、ICU주원시간[분별위(9.50±3.70)、(7.72±3.29)、(8.02±2.90)d,F치위3.28]、궤계통기시간[분별위(8.92±3.79)、(7.23±3.32)、(7.37±2.99)d,F치위3.09]、△APACHEⅡ평분[분별위8.87±3.46、7.20±2.81、7.42±3.18,F치위3.30]화△MODS평분[분별위4.15±2.15、3.20±1.48、3.32±1.74,F치위3.23]차이구유통계학의의(P균＜0.05),차IIT1、IIT2조여CIT조비교,차이균유통계학의의(P균＜0.05),단량개아조지간차이무통계학의의(P＞0.05).결론 IIT대농독증환자VEC구유보호작용,차장혈당공제재6.6～8.3mmol/L가이명현강저저혈당적발생솔,동시IIT가이명현개선농독증환자적개치.
    Objective To investigate the effects of intensive insulin therapy on the functions of vascullar endothelial cells in septic patients. Methods One hundred and twenty septic patients were randomly assigned to intensive insulin therapy 1 ,intensive insulin therapy 2 and conventional insulin therapy, serum von Willebrand factor (vWF),thrombomodulin protein(TM),endothelin-1 (ET-1) and nitric oxide(NO) of the three groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle (ELISA) before treatment and the next 3 d,7 d after treatment. At the same time we observed the three groups of patients with 28-d mortality, the days of hospitalized in ICU, number of days for using mechanical ventilation, △ APACHE Ⅱ score and △MODS score. Results After treatment of 3 days,vWF was (142.57 ± 10.07)%, (137.32 ±9.66)% and (138. 32 ± 8. 80) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, vWF was (126.27 ±10.49) %, (116. 55 ± 9. 36) % and (120.72 ± 9. 53) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, TM was (6. 87 ± 1.62) μg/L, (5.95 ± 1.60) μg/L and (6. 17 ± 1.33) μg/L in the CIT, IIT1and IIT2 group, respectively. After treatment of 7 days, TM was (4. 55 ± 1.48) μg/L, (3.35 ± 0.94) μg/L and(3. 87 ± 1.20) μg/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, ET-1 was (61.27 ±9. 20) ng/L, (55.97 ± 9.03) ng/L and (57. 37 ± 7. 70) ng/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, TM was (43. 12 ± 6. 17) ng/L, (33.77 ± 6. 20) ng/L and (35.95 ± 5.73) ng/L in the CIT, IIT1and IIT2 group, respectively. Compared with conventional insulin therapy, vWF, TM and ET-1 were significantly decreased (P ＜ 0.05), NO were significantly higher (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups had no significant difference (P ＞ 0.05). In the CIT, IIT1 and IIT2 groups respectively, the mortality at 28 days were 20.0%, 12. 5 % and 45.0%, the days of hospitalized in ICU were (9.50 ± 3. 70) d, (7. 72 ± 3.29) d and (8.02 ±2. 90) d, number of day for using mechanical ventilation were (8. 92 ± 3.79) d, (7.23 ± 3. 32) d and (7. 37 ±3. 29) d, △ APACHE Ⅱ score were 8. 87 ± 3.46,7. 20 ± 2. 81 and 7.42 ± 3. 18, △ MODS score were 4. 15 ± 2. 15,3.20 ± 1.48 and 3.32 ± 1.74, with significant differences (P ＜ 0.05). These indices were significantly decreased (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups also had no significant differences (P ＞ 0.05). Conclusions Intensive insulin therapy on patients with sepsis has a protective effect of vascular endothelial cells, and the blood glucose controlled in the 6. 6 - 8. 3 mmol/L can significantly decrease the incidence of hypoglycemia, and intensive insulin therapy can also significantly improve the prognosis of patients with sepsis.
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