全身炎症反应综合征患者血清炎症介质与血糖的相关性研究

目的探讨全身炎症反应综合征（SIRS）患者血清细胞因子和血糖的浓度变化及其对预后的影响。方法将患者分为SIRS组（78例）和非SIRS组（35例）；SIRS组分为生存亚组（37例）和死亡亚组（41例）；在SIRS组中随机选择血糖水平〉6．1mmol／L者进行胰岛素强化治疗。测定IL-6、IL-10、IL-13、肿瘤坏死因子（TNF-α）的血清浓度和单核细胞人类白细胞DR抗原（HLA-DR）表达强度。结果入院5d后，血清IL-6、TNF—α及血糖水平SIRS组较非SIRS组明显增高，分别为（80±38）×10^3μg／L与（42±7）×10^3μg／L、（52±20）×10^3μg／L与（17±6）×10^3μg／L、（11．9±1．1）mmol／L与（6．5±1．5）mmol／L；死亡组较生存组患者亦明显增高，分别为（108±21）×10^3μg／L与（66±22）×10^3μg／L、（28±8）×10^3μg／L与（16±9）×10^3μg／L、（14．4±2．1）mmol／L与（7．0±1．0）mmol／L。IL-10、IL-13和HLA—DR表达强度的变化却相反。胰岛素强化治疗可以扭转上述变化，降低死亡率。结论SIRS患者的血糖变化可以在一定程度上反映危重患者机体的免疫状态、评估疾病的严重程度。

Blood cytokines and glucose levels in patients with systemic inflammatory response syndrome

Objective To investigate the changes of serum inflammatory factors and blood glucose in patients with systemic inflammatory response syndrome (SIRS) . Methods Seventy eight SIRS patients were divided into survival subgroup (n =37) and fatal subgroup ( n = 41), 35 non-SIRS patients were designated as control group. Thirty eight out 76 patients whose blood glucose was higher than 6. 1 mmol/L were randomly selected for intensive insulin therapy. Serum IL-6, IL-10, IL-13, TNF-α and blood glucose were measured; HLA-DR expression on monocytes was detected. Results Serum IL-6, TNF-αand blood glucose levels were (80±8) vs. (42±7)×10~3μg/L, (52±20) vs. (17±6) ×10~3μg/L and (11.9±1.1)vs.(6.5±1.5)mmoL/L in SIRS vs.non-SIRS group respectively(all P＜0.05);those were(108±21)vs.(66±22)×10~3μg/L,(28±8)vs.(16±9)×10~3μg/L,(14.4±2.1)vs.(7.0±1.0)mmol/L in fatal vs.survival group,respectively(all P＜0.05).The changes of IL-10,IL-13 and HLA-DR expression intensity of monocyte showed a reverse trend.The intensive insulin therapy reversed the above tendency and reduced the fatality rate.Conclusions Blood glucose levels are corrected with serum cytokines in SIRS patients and reflex the immune status and disease prognosis.Intensive insulin therapy can improve the prognosis of SIRS patients.