胰岛素受体改变及血糖控制对危重症患者的影响

目的 探讨术后重症患者胰岛素受体的变化规律及严格血糖控制对其功能的影响.方法 以19例APACHEⅡ评分≥10分的术后重症患者为研究对象,根据血糖控制目标随机分为严格血糖控制组(控制血糖在4.4～6.7 mmol/L)和高血糖组(控制血糖在8.3～10.0 mmol/L).持续静脉泵入胰岛素控制血糖,记录血糖值和胰岛素用量.同时测定红细胞胰岛素受体(InsR)数目和亲和常数(K).结果 全部患者均出现血糖升高;术后第1天的红细胞胰岛素受体数目及亲和常数均明显低于正常,第2、4、7天逐渐恢复,但仍低于正常水平;APACHEⅡ评分≥15分者,第1天红细胞胰岛素受体数目、亲和常数明显低于APACHEⅡ评分＜15分的患者;平均每日胰岛素用量随红细胞胰岛素受体的恢复而逐渐减少,两者呈负相关;严格血糖控制组红细胞胰岛素受体数目和亲和常数的恢复明显好于高血糖组.两组间每日平均胰岛素用量无明显差异.结论 胰岛素受体的改变在应激性高血糖的发生中起一定作用,血糖正常化可能有助于胰岛素受体的恢复.

Changes of insulin receptor in patients with critical illness and hyperglycemia and effect of intensive insulin therapy on it

Objective To investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it.Methods Nineteen adult patients were admitted to surgical intensive care unit(SICU)and randomly assigned into two groups:intensive glucose controlled group(to control glucose at 4.4-6.7 mmol/L)and hyperglycemia group(to control glucose at 8.3-10.0 mmo]/L).Blood glucose Was controlled with using continuing insulin infusion.The expression of insulin receptors(InsR)of pefipheral erythrocyte was detected by radioligand assay methods on the morning of day1,2,4,7 after admitted to SICU.Daily usage of insulin and APACHE Ⅱ score were recorded.The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE Ⅱ were analyzed Results The number and affinity constant of erythrocyte insulin reeeptors was decreased significantly in day 1 and 2 in both groups,and recovered gradually in day 4 and 7,and significant difierence was found between the patients with APACHEⅡ≥15 and those with APACHE Ⅱ＜15.The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hypeglycemia group.Conclusions It indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients.and it plays a role in stress induced hyperglycemia.Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.