CAJ | 학술논문

【目的】探究他汀类药物对糖尿病（DM ）合并严重感染患者预后的影响。【方法】选取2011年7月至2013年7月入住开滦总医院赵各庄医院内分泌科和开滦总医院重症医学科（ICU ）的DM 合并严重感染的患者共210例，采用随机分组，分为辛伐他汀治疗组（T组）和对照组（C组），各105例。两组患者均给予针对原发病的治疗以及充分的抗感染、营养、对症支持治疗，在此基础上，T组患者在入选当晚即给予辛伐他汀40 mg ，口服或鼻饲，连续14 d。测定和对比两组患者用药前（T1）、用药后4 d（T2）、7 d（T3）的急性生理与慢性健康评分、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-10（IL-10）浓度、多器官功能不全综合征（MODS）发生率和28 d病死率。【结果】T组患者T2和T3时的IL-6、TNF-α、CRP水平都比前时间点及C组同时间点低（ P ＜0．05），IL-10水平比前一时间及C组同时间点高（ P ＜0．05）；C组患者 T3时的IL-6、TNF-α、CRP水平都比T1时低（ P ＜0．05），IL-10水平比 T1时高（ P ＜0．05），T 组 T3后患者MODS发生率（8．57％）明显小于C组患者（35．23％，P＜0．01）；28 d病死率（3．81％）小于C组患者（17．14％，P＜0．05）。【结论】他汀类药物对DM合并严重感染患者，能够减轻炎性反应，能降低MODS发生率及28 d病死率，进一步改善患者预后，具有一定的临床应用价值。
【목적】탐구타정류약물대당뇨병（DM ）합병엄중감염환자예후적영향。【방법】선취2011년7월지2013년7월입주개란총의원조각장의원내분비과화개란총의원중증의학과（ICU ）적DM 합병엄중감염적환자공210례，채용수궤분조，분위신벌타정치료조（T조）화대조조（C조），각105례。량조환자균급여침대원발병적치료이급충분적항감염、영양、대증지지치료，재차기출상，T조환자재입선당만즉급여신벌타정40 mg ，구복혹비사，련속14 d。측정화대비량조환자용약전（T1）、용약후4 d（T2）、7 d（T3）적급성생리여만성건강평분、C반응단백（CRP）、종류배사인자-α（TNF-α）、백개소-6（IL-6）、백개소-10（IL-10）농도、다기관공능불전종합정（MODS）발생솔화28 d병사솔。【결과】T조환자T2화T3시적IL-6、TNF-α、CRP수평도비전시간점급C조동시간점저（ P ＜0．05），IL-10수평비전일시간급C조동시간점고（ P ＜0．05）；C조환자 T3시적IL-6、TNF-α、CRP수평도비T1시저（ P ＜0．05），IL-10수평비 T1시고（ P ＜0．05），T 조 T3후환자MODS발생솔（8．57％）명현소우C조환자（35．23％，P＜0．01）；28 d병사솔（3．81％）소우C조환자（17．14％，P＜0．05）。【결론】타정류약물대DM합병엄중감염환자，능구감경염성반응，능강저MODS발생솔급28 d병사솔，진일보개선환자예후，구유일정적림상응용개치。
[Objective] To explore the effect of statins on the prognosis of diabetic (DM ) patients with se-vere infection .[Methods] Totally 210 patients with DM and severe infection in endocrinology department and intensive care unit(ICU) department of Zhaogezhuang hospital of Kailuan general hospital from July 2011 to July 2013 were selected .All patients were randomly divided into simvastatin group (group T ) and control group(group T ) with 105 patients in each group .Patients in two groups were given the treatment of primary disease ,anti-infection ,nutrition and symptomatic support therapy .On the basis of above treatment ,group T was given oral or nasal simvastatin 40mg from the day of enrollment for 14 days .Acute physiological and chro-nic health score , levels of CRP , TNF-α, IL-6 , IL-10 , the incidence of multiple organ dysfunction score (MODS) and 28d fatality rate in two groups before(T1 ) ,4 d(T2 ) and 7 d(T3 ) after medication were measured and compared .[Results] The levels of IL-6 ,TNF-αand CRP in group T at T2 and T3 were lower than those in group T at T1 and in group C at T2 and T3 ( P<0 .05) ,and the levels of IL-10 were higher than those in group T at T1 and group C at T2 and T3 ( P<0 .05) .The levels of IL-6 ,TNF-αand CRP in group C at T3 were low-er than those at T1 ( P <0 .05) ,but the levels of IL-10 were higher than those at T1 ( P <0 .05) .The inci-dence of MODS in group T at T3 was 8 .57% ,which was obviously lower than that in group C(35 .23% )( P<0 .01) .The 28d fatality rate in group T at T3 was lower than that in group C(3 .81% vs .17 .14% )( P <0 .05) .[Conclusion] Statins for the treatment of DM patients with severe infection can decrease inflammatory response ,reduce the incidence of MODS and the 28d fatality rate and further improve the prognosis of pa-tients .Therefore they have certain clinical application value .