早期胰岛素强化治疗对严重脓毒症患者肠黏膜通透性及炎症状况的影响(1)
[摘要] 目的 探討早期胰岛素强化治疗对严重脓毒症患者肠黏膜通透性及炎症状况的影响。 方法 选取2016年5月～2018年8月严重脓毒症患者72例，随机分为两组。两组均予抗感染治疗、营养支持和治疗原发感染灶等治疗。两组均予以普通胰岛素加入微泵持续泵入，强化组与对照组分别将维持血糖在4.4～6.1 mmol/L和10.0～11.1 mmol/L，连用7 d。观察两组治疗前后肠黏膜通透性指标及炎症状况变化，并评估疗效。 结果 治疗7 d后，两组内毒素(ET)、肠型脂肪酸结合蛋白(IFABP)和D-乳酸水平显著下降(P<0.01或P<0.05)，且强化组下降幅度更明显(P<0.05);两组血清hs-CRP和IL-6水平显著下降，IL-10水平显著上升(P<0.01或P<0.05)，且强化组下降或上升幅度更明显(P<0.05);同时，强化组临床总有效率要高于对照组(86.11% vs 69.44%)(χ2=5.24，P<0.05)。 结论 早期胰岛素强化治疗严重脓毒症患者可降低血清ET、IFABP、D-乳酸、hs-CRP和IL-6水平，增加血清IL-10水平，其降低肠黏膜通透性可能与控制炎症反应密切相关。
[关键词] 严重脓毒症;胰岛素;强化治疗;肠黏膜通透性;炎症状况
[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701(2019)24-0015-04
[Abstract] Objective To investigate the effect of early intensive insulin therapy on intestinal mucosal permeability and inflammatory status in patients with severe sepsis. Methods 72 patients with severe sepsis from May 2016 to August 2018 were randomLy divided into two groups. Both groups were treated with anti-infective treatment， nutritional support and treatment of primary infection. Both groups were given ordinary insulin added to the micropump for continuous pumping. The intensive group and the control group maintained blood glucose of 4.4-6.1 mmol/L and 10.0-11.1 mmol/L， respectively， for 7 days. The changes of intestinal mucosal permeability and inflammatory status between two groups before and after treatment were observed and the therapeutic effects were evaluated. Results After 7 days of treatment， the levels of endotoxin (ET)， intestinal fatty acid binding protein (IFABP) and D-lactic acid in two groups were significantly decreased (P<0.01 or P<0.05)， and the decrease in the intensive group was more significant(P<0.05). Serum hs-CRP and IL-6 levels in two groups were significantly decreased， and IL-10 levels were significantly increased (P<0.01 or P<0.05). And the increase or decrease was more significant in the intensive group(P<0.05). At the same time， the total clinical effective rate in the intensive group was higher than that of the control group (86.11% vs 69.44%) (χ2=5.24， P<0.05). Conclusion Early intensive insulin therapy in the treatment of severe sepsis can reduce serum ET， IFABP， D-lactic acid， hs-CRP and IL-6 levels， increase serum IL-10 levels. Its reduction of intestinal mucosal permeability may be closely related to the control of inflammatory response.
[Key words] Severe sepsis; Insulin; Intensive therapy; Intestinal mucosal permeability; Inflammatory condition, http://www.100md.com(蔡学英 刘炳炜 骆德强)
[关键词] 严重脓毒症;胰岛素;强化治疗;肠黏膜通透性;炎症状况
[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701(2019)24-0015-04
[Abstract] Objective To investigate the effect of early intensive insulin therapy on intestinal mucosal permeability and inflammatory status in patients with severe sepsis. Methods 72 patients with severe sepsis from May 2016 to August 2018 were randomLy divided into two groups. Both groups were treated with anti-infective treatment， nutritional support and treatment of primary infection. Both groups were given ordinary insulin added to the micropump for continuous pumping. The intensive group and the control group maintained blood glucose of 4.4-6.1 mmol/L and 10.0-11.1 mmol/L， respectively， for 7 days. The changes of intestinal mucosal permeability and inflammatory status between two groups before and after treatment were observed and the therapeutic effects were evaluated. Results After 7 days of treatment， the levels of endotoxin (ET)， intestinal fatty acid binding protein (IFABP) and D-lactic acid in two groups were significantly decreased (P<0.01 or P<0.05)， and the decrease in the intensive group was more significant(P<0.05). Serum hs-CRP and IL-6 levels in two groups were significantly decreased， and IL-10 levels were significantly increased (P<0.01 or P<0.05). And the increase or decrease was more significant in the intensive group(P<0.05). At the same time， the total clinical effective rate in the intensive group was higher than that of the control group (86.11% vs 69.44%) (χ2=5.24， P<0.05). Conclusion Early intensive insulin therapy in the treatment of severe sepsis can reduce serum ET， IFABP， D-lactic acid， hs-CRP and IL-6 levels， increase serum IL-10 levels. Its reduction of intestinal mucosal permeability may be closely related to the control of inflammatory response.
[Key words] Severe sepsis; Insulin; Intensive therapy; Intestinal mucosal permeability; Inflammatory condition, http://www.100md.com(蔡学英 刘炳炜 骆德强)