摘要
目的:观察外科感染病人胰岛素抵抗(IR)状况,研究其临床意义,并探讨如何应用临床常用参数评价感染病人的胰岛素敏感性(ISI)。方法:检测外科不同病情严重程度感染患者空腹血糖(FBG)、空腹胰岛素(FINS),以正常健康人为对照,利用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-)β,观察外科感染病人ISI,并且分析不同病情严重程度和不同病种感染病人之间ISI是否存在显著差异。使用多元线性回归方程和多因素Logistic进行多因素分析,应用临床常用的参数评价感染ISI状况。结果:①外科感染病人中IR发生率为92.06%(58/63)。不同病种,包括急性重症胰腺炎病人、肠瘘病人和急性胆管炎病人,不论HOMA-IRl、gHOMA-IR还是HOMA-β均无显著差异(P>0.05)。②按病情严重度和最终预后对病人分组:SIRS病人IR发生率为20%(7/35),脓毒症病人IR发生率为86.20%(25/29),脓毒性休克和MODS组病人IR发生率为95.83%(23/24),死亡组病人IR发生率为100%(10/10)。各组间IR有显著差异(P<0.01),而HOMA-β无显著差异(P>0.05)。③临床各常用参数与ISI之间相关性分析显示器官功能衰竭连续评分(sequential organ failure assessment,SOFA)、FINS、FBG、转铁蛋白、脓毒症评分(sepsis scores,SS)评分、C-反应蛋白(CRP)、前白蛋白、三酰甘油(TG)和胰岛素用量/葡萄糖用量与ISI呈独立正相关,方程的R2为0.900。各临床参数对IR的多因素Logistic回归显示FINS、FBG、低密度脂蛋白(LDL)和SOFA进入模型,其中FBG和FINS与IR的回归关系更明显,而其他临床指标与IR未显示有意义的回归关系。结论:①外科感染病人中普遍存在IR,并与引起感染的病种无关;②IR与疾病严重程度最终预后密切相关,可作为判断危重病人病情转归和预后的预警指标;③临床常用参数SOFA评分、FINS、FBG、转铁蛋白、SS评分、CRP、前白蛋白和TG与感染病人ISI的关系更为密切。
Objective To observe the status and clinical significance of insulin resistance （IR） in surgical patients with sepsis, and investigate the way to evaluate the insulin sensitivity index （ISI） in patients with sepsis by using clinical parameters. Method The concentrations of fasting blood glucose （FBG） and fasting insulin （FINS） were detected in patients with various degrees of sepsis. Normal healthy persons were served as controls. Homeostasis model assessment （HOMA） was used to calculate the index of insulin resistance （HOMA-IR） and the index of insulin secretion （HOMA-β）. Insulin sensitivity was observed in surgical patients with sepsis, and analysis was made whether there existed significant deviation between the ISI and severity of disease. Several clinical common parameters were used in the evaluation of ISI through multiple linear regression and multiple factor Logistic regression. Results ① The incidence rate of IR in surgical patients with sepsis was 92.06% （58/63）. There were no significant deviations among different disease entities, including severe acute pancreatitis, intestinal fistula and acute cholangitis in HOMA-IR （P〉0.05）, lgHOMA-IR （P〉0.05） or HOMA-β （P〉0.05）. ②The patients were grouped into SIRS group, sepsis group, septic shock and MODS group, and death group, according to their disease severity and prognosis; the incidence rate in these five groups were respectively： 20% （in patients with SIRS）, 86.20% （in patients with sepsis）, 95.83% （23/24） （in patients with septic shock and MODS, and 100% （in death group）. There were significant deviations in IR （P〈0.01）, while there were no significant deviations in HOMA-β among these five groups （P〉0,05）. ③ The results showed that sequential organ failure assessment （SOFA）, FINS, FBG, concentration of plasma siderophilin, sepsis scores （SS）, C-reactive protein （CRP）, concentration of plasma prealbumin, triglyceride, siderophilin, and insulin doses/glucose doses were independently positively correlated with ISI; the R^2 of the equations was 0.900. The multiple factor Logistic regression showed that FINS, FBG, LDL and SOFA were in model. Conclusions ① Insulin resistance generally exists in surgical patients with sepsis, regardless of the causes. ② IR is closely correlated with disease severity and its final outcome. ISI can be used to forecast the prognosis of patients with sepsis. ③ There exists linear regression between ISI and several clinical parameters, such as SOFA, FINS, FBG, SS, CRP, and concentration of plasma siderophilin, prealbumin and triglyceride.
出处
《外科理论与实践》
2006年第1期14-19,共6页
Journal of Surgery Concepts & Practice
基金
军队"十五"科研基金重点资助项目(批准号:01Z011)
