摘要
目的通过胰岛素强化治疗对严重创伤患者CD14+单核细胞比率及CD14+单核细胞人白细胞抗原-DR(HLA-DR)表达的影响,探讨强化治疗在严重创伤后的抗炎与免疫调节作用的效果和临床价值。方法采用随机配对分组的研究方法,对外科ICU收治的损伤严重程度评分(ISS)>20分的严重创伤患者分别给予胰岛素强化治疗(血糖目标值6~8mmol/L)和常规治疗(血糖目标值<11.1 mmol/L)。分别在入院后0、2、4、6、8 d留取外周静脉血,采用流式细胞技术检测CD14+单核细胞HLA-DR表达率。结果胰岛素强化治疗组随着强化治疗时间增加,CD14+单核细胞HLA-DR表达下降,具有统计学意义(P<0.05或P<0.01);与常规治疗组相比较,胰岛素强化治疗在不同时间点对CD14+单核细胞比率无明显影响(P>0.05)。结论胰岛素强化治疗在控制创伤后应激性血糖升高的同时,保护了伤后脏器功能,增强天然免疫防御反应的同时,也有诱导创伤后免疫抑制的风险。在严重创伤早期实施有选择性和适度的胰岛素强化治疗对危重患者更为可取。
Objective To study the influence of intensive insulin therapy on rate of CD14^＋ monocyt and expression of CD14^＋ monocyt human leukocyte antigen DR （ HLA - DR） in severe trauma patients, and to investigate the role of protection to serious illness. Methods Insulin therapy directed at establishing euglycemia was investigated in 32 sICU injured patients ISS〉20, tailored to control blood glucose levels in the range 6- 8 mmol/L, where as the conventional treatment group only received insulin when glucose levels exceeded 11.1 mmol/L. Blood samples were obtained at 0, 2, 4, 6 and 8 days after admission. Two - color flow cytometric {FCM） analysis was used for the detection of the human leukocyte antigen HLA- DR expression on CD14^＋ monocytes. Results Monocyte HLA- DR expressions were comparatively lower after using of insulin protocols, compared with the conventional approach. Conclusions Intensive insulin therapy improves blood glucose control and protects organ functions in injured patients. Attenuating the systemic inflammatory response to trauma, as well as its glycemia controlling effects, may contribute to the improved outcomes of sever trauma patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2006年第7期481-484,共4页
Chinese Journal of Critical Care Medicine
基金
国家重点基础研究发展规划项目(973项目
No.2005-CB522602)
国家杰出青年基金项目(No.30125020)
首都医学发展基金重点项目(No.2003-2023)
