强化胰岛素治疗对脓毒症患者血清血管性假血友病因子、内皮素1和一氧化氮浓度及预后的影响

目的：探讨强化胰岛素治疗（IIT）对脓毒症患者血清血管性假血友病因子（v WF）、内皮素1（ET-1）和一氧化氮（NO）浓度及预后的影响。方法：将90例脓毒症患者随机分为强化胰岛素治疗组（IIT组）和常规胰岛素治疗组（CIT组）。在治疗前、治疗后3 d、7 d用酶联免疫吸附法（ELISA）检测2组患者血清v WF、ET-1和NO的浓度。同时记录2组患者ICU住院时间、机械通气时间、ICU最后1 d的APACHEⅡ评分、28 d病死率及低血糖发生率。结果：IIT组患者血清v WF、ET-1浓度较CIT组均明显降低（P〈0.05）,NO浓度较CIT组均明显升高（P〈0.05）,且IIT组患者ICU住院时间、机械通气时间、ICU最后1 d的APACHEⅡ评分、28 d病死率较CIT组均明显降低（P〈0.05）,但两组患者低血糖发生率相近（P〉0.05）。结论：IIT可以使脓毒症患者血清v WF、ET-1浓度降低及NO浓度升高,同时可以降低患者病死率,改善预后。

Effects of intensive insulin therapy on the prognosis and serum vWF,ET-1 and NO levels in patients with sepsis

AIM：To investigate the effects of intensive insulin therapy on the prognosis and serum vWF,ET-1,NO levels in patients with sepsis. METHODS：Ninety patients were randomly assigned to intensive insulin therapy group and conventional insulin therapy group,serum von Willebrand factor（vWF）,endothelin-1（ET-1） and nitric oxide（NO） of the two groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle（ELISA） before treatment and the next 3 d,7 d after treatment.At the same time we observed the two groups of patients with the days of hospitalized in ICU,number of days for using mechanical ventilation,the last day of APACHE II score in ICU and incidence rate of hypoglycemia and 28 d mortality.RESULTS：Compared with conventional insulin therapy group,vWF,TM and ET-1 levels in intensive insulin therapy group were significantly decreased（P0.05）,NO were significantly higher（P0.05）;and the days of hospitalized in ICU,number of day for using mechanical ventilation,the last day of APACHE II score in ICU,28-d mortality were significantly decreased（P 0.05）in intensive insulin therapy group,and incidence rate of hypoglycemia of two group had no difference（P0.05）.CONCLUSION：Intensive insulin therapy in patients with sepsis can reduce serum vWF,ET-1 levels and elevate NO levels,at the same time can reduce the case-fatality rate of patients,improve the prognosis.