严重脓毒症患者胰岛素抵抗和胰岛素分泌与疾病严重程度及预后的相关性

摘要

Objective To investigate the correlation among insulin secretion, insulin resistance (IR), the se-verity of disease and prognosis in patients with severe sepsis. Methods Forty-two patients with severe sepsis were selected in ICU of our hospital as the observation group, which were divided into the survival group (24 cases) and death group (18 cases), according to the outcome. Thirty healthy people were chosen as the control group. Serum fast-ing blood glucose (FBG), insulin (FINS) concentration of patients before treatment, after treatment were observed and compared. Steady-state model method (HOMA) were used to calculate insulin secretion index (HOMA-β) and insulin resistance index (HOMA-IR). Results ①FBG, FINS levels before treatment of the observation group were signifi-cantly higher than those of the control group (P<0.05); HOMA-βwas lower than that of control group, while HOMA-IR was higher than that of control group. The differences were all statistically significant (P<0.05).②FBG, HOMA-βand HOMA-IR of the survival group at admission showed statistically significant differences with those in the death group (P<0.05); One month after treatment, the FBG, FINS, HOMA-β and HOMA-IR were significantly lower than those at admission and those in the death group (P<0.05);③FBG, FINS and HOMA-IR in patients with single organ dysfunction was significantly lower than those in patients with multiple organ dysfunction, while the HOMA-beta were significantly higher (P<0.05); ④ The APACHE Ⅱ score of the observation group was (21.34+5.43), with (26.75+7.65) in the death group and (17.65+4.54) in the survival group. The APACHEⅡwas positively correlated with FBG and HOMA-IR (r=0.51, 0.44, P<0.05), and negatively correlated with HOMA-β (r=-0.53, P<0.05). Conclusion Patients with severe sepsis have hyperglycaemia and insulin resistance, and hyperglycaemia can interfere with the patient's recovery. FBG, HOMA-βand HOMA-IR can be used as evaluation indexes for the severity and prognosis of the disease.%目的：探讨严重脓毒症患者胰岛素抵抗(IR)和胰岛素分泌与疾病严重程度及患者预后的关系。方法观察组选取我院ICU严重脓毒症患者42例，根据患者转归分为生存组24例和死亡组18例，对照组选取健康查体者30例，观察并对比分析各组血清中空腹血糖(FBG)、胰岛素(FINS)浓度，并应用稳态模式法(HOMA)分别计算胰岛素分泌指数(HOMA-β)以及胰岛素抵抗指数(HOMA-IR)。结果①治疗前，观察组患者FBG、FINS水平明显高于对照组(P<0.05)，HOMA-β明显低于对照组，HOMA-IR高于对照组，差异均有统计学意义(P<0.05)；②生存组入院时FBG、HOMA-β及HOMA-IR与死亡组比较差异均有统计学意义(P<0.05)；治疗1个月后FBG、FINS、HOMA-β及HOMA-IR四项指标均明显低于刚入院时及死亡组(P<0.05)；③单脏器功能不全患者FBG、FINS及HOMA-IR显著低于多脏器功能不全患者，HOMA-β明显高于多脏器功能不全者，差异均有统计学意义(P<0.05)；④观察组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分为(21.34±5.43)分，其中死亡组(26.75±7.65)分，生存组(17.65±4.54)分。观察组APACHEⅡ评分与FBG及HOMA-IR呈正相关(r=0.51，0.44， P<0.05），与HOMA-β呈负相关(r=-0.53，P<0.05)。结论严重脓毒血症患者存在高血糖及胰岛素抵抗，且高血糖能够干扰患者病情恢复；FBG、HOMA-β及HOMA-IR能够作为评估病情严重及预后的指标。