重度烧伤患者血糖与炎性因子及免疫功能的相关性研究

目的研究重度烧伤患者血糖与炎性因子及免疫功能的相关性。 方法选取2012年1月至2017年12月在成都医学院第一附属医院烧伤整形外科治疗的重度烧伤患者96例作为试验组，另选取成都医学院第一附属医院经体检证明健康的志愿者60名作为对照组，检测两组空腹血糖(FPG)、炎性因子及T淋巴细胞水平，比较两组间FPG、炎性因子以及T淋巴细胞水平之间的差异；再将试验组患者根据FPG浓度分为血糖正常组(17例，FPG <7.0 mmol/L)和血糖升高组(79例，FPG≥7.0 mmol/L)，比较两组炎性因子以及T淋巴细胞水平之间的差异，并对重度烧伤患者的FPG与炎性因子及T淋巴细胞水平进行Pearson相关性分析。指标比较采用t检验。 结果试验组患者FPG(11.39±2.28) mmol/L、C反应蛋白(CRP)(39.67±4.15) mg/L、肿瘤坏死因子-α (TNF-α) (108.12±6.49) ng/L、白细胞介素(IL)-6 (139.77±7.43)ng/L、IL-8(91.56±4.91)ng/L，均高于对照组[FPG(5.07±1.15) mmol/L、CRP(5.91±0.76) mg/L、TNF-α(12.94±1.69) ng/L、IL-6(14.11±3.93) ng/L、IL-8(17.22±2.89) ng/L]，差异均有统计学意义(t＝5.365、4.365、11.912、9.834、6.139，P值均小于0.01)；试验组患者免疫指标CD4^＋ T淋巴细胞水平为(29.77±4.12)%、CD4^＋/CD8^＋为0.91±0.24，分别低于对照组(41.89±5.36)%、1.59±0.37，而试验组的CD8^＋ T淋巴细胞水平为(32.69±4.73)%，高于对照组(25.83±3.52)%，差异均有统计学意义(t＝3.931、2.433、2.696，P值均小于0.05)。试验组患者中，血糖升高组的血浆CRP(45.19±5.45) mg/L、TNF-α(121.81±5.43) ng/L、IL-6(153.31±5.57) ng/L、IL-8(106.56±5.65) ng/L、CD8^＋T淋巴细胞水平(35.46±4.11)%，均高于血糖正常组[CPR(36.67±3.45) mg/L、TNF-α(91.58±4.93) ng/L、IL-6(114.65±6.33) ng/L、IL-8(79.62±3.74) ng/L、CD8^＋ T淋巴细胞水平(28.62±4.03)%]，差异均有统计学意义(t＝2.341、2.894、4.167、3.018、2.763，P值均小于0.05)；CD4^＋ T淋巴细胞水平(28.89±3.79)%、CD4^＋/CD8^＋(0.82±0.37)均低于血糖正常组[(33.47±4.98)%、(1.17±0.52)]，差异均有统计学意义(t＝2.158、2.247，P值均小于0.05)；FPG与CRP、TNF-α、IL-6、IL-8以及CD8^＋T淋巴细胞呈正相关(r＝0.651、0.571、0.781、0.425、0.543，P值均小于0.05)，与CD4^＋T淋巴细胞、CD4^＋/CD8^＋呈负相关(r＝－0.636、－0.519，P值均小于0.05)。 结论重度烧伤患者机体会发生应激反应，出现应激性高血糖且机体内炎性因子及免疫功能会发生明显的改变，血糖与炎性因子及免疫水平有显著的相关性，血糖越高者，机体炎症反应越明显，免疫功能越低下。

Correlation research of blood glucose with inflammatory factors and immune function in patients with severe burn

ObjectiveTo investigate the correlation between blood glucose levels, inflammatory factors and immune function of patients who suffered from severe burns. MethodsA sample size of 96 severe burns patients were chosen at Department of Burns and Plastic Surgery, First Affiliated Hospital of Chengdu Medical College over the period of January 2012 to December 2017, to serve as the experimental group; while 60 healthy volunteers after physical examination from First Affiliated Hospital of Chengdu Medical College served as control group. The fasting blood glucose (FPG) level, inflammatory factors, and T-lmphocytes levels for both two groups were studied, and the differences between FPG, inflammatory factors, and T-lymphocytes levels were compared between the two groups. The patients in the experimental group were divided into normal blood glucose group (FPG <7.0 mmol/L) with 17 cases and high blood glucose group (FPG≥7.0 mmol/L) with 79 cases according to the FPG concentration. Data were compared with t test. ResultsThe experimental group had FPG (11.39±2.28) mmol/L, C-reactive protein(CRP) was (39.67±4.15) mg/L, tumor necrosis factor-α(TNF) was (108.12±6.49) ng/L, interleukin(IL)-6 was (139.77±7.43) ng/L, IL-8 (91.56±4.91) ng/L, higher than the control group [FPG(5.07±1.15) mmol/L, CRP was (5.91±0.76) mg/L, TNF-α was (12.94±1.69) ng/L, IL-6 was (14.11±3.93) ng/L, IL-8 was (17.22±2.89) ng/L], the differences were statistically significant (t=5.365, 4.365, 11.912, 9.834, 6.139; with P values below 0.05); in the experimental group, the immune index, CD4⁺ T-lymphocytes level was (29.77±4.12)% and CD4⁺ /CD8⁺ was 0.91±0.24, which were lower than those of the control group (41.89±5.36)% and 1.59±0.37. The CD8⁺ T-lymphocytes level in the experimental group was (32.69± 4.73)%, which was higher than the control group [(25.83±3.52)%], the differences were statistically significant (t=3.931, 2.433, 2.696; with P values below 0.05). In the experimental group, plasma CRP was (45.19±5.45) mg/L, TNF-α was (121.81±5.43) ng/L, IL-6 was (153.31±5.57) ng/L, IL-8 was (106.56±5.65) ng/L and CD8⁺ T-lymphocytes was (35.46±4.11)% in the high blood glucose group, which were higher than normal blood glucose group [CRP (36.67±3.45) mg/L, TNF-α (91.58±4.93) ng/L, IL-6 (114.65±6.33) ng/L, IL-8 (79.62±3.74) ng/L, CD8⁺ T-lymphocytes level (28.62±4.03)%], the differences were statistically significant (t=2.341, 2.894, 4.167, 3.018, 2.763; with P values below 0.05); CD4⁺ T-lymphocytes level (28.89±3.79)% and CD4⁺ /CD8⁺ (0.82±0.37) were lower than those in the normal blood glucose group [(33.47±4.98)%, 1.17±0.52], and the differences were statistically significant (t=2.158, 2.247; with P values below 0.05). There were positive correlation between FPG and CRP, TNF-α, IL-6, IL-10 and CD8⁺ T-lymphocytes level (r=0.651, 0.571, 0.781, 0.425, 0.543; with P values below 0.05), which were negatively correlated with CD4⁺ T-lymphocytes level and CD4⁺ /CD8⁺ (r=-0.636, -0.519; with P values below 0.05). ConclusionSeverely burned patients will experience stress reaction, stress hyperglycemia and significant changes in the body′s inflammatory factors and immune function, blood glucose and inflammatory factors and immune levels have a significant correlation, the higher the blood sugar, the more pronounced the inflammatory reaction is, the lower the immune function is.