胰岛素泵强化治疗糖尿病并重症肺部感染及对血清和肺泡灌洗液中炎症因子的影响

Effect of insulin pump intensive treatment on inflammatory factors in serum and bronchoalveolar lavage fluid and diabetes complicated with severe pulmonary infection

摘要:

目的 探讨胰岛素泵强化治疗糖尿病并重症肺部感染患者的效果和预后情况及对血清和肺泡灌洗液中炎症因子的影响。方法 选取2015 年11 月-2016 年10 月于河南理工大学第一附属医院收治的糖尿病合并重症肺部感染患者172 例，随机分为胰岛素泵强化组（观察组）和对照组，每组各86 例。观察组应用内装有门冬胰岛素的胰岛素泵强化治疗，对照组应用甘精胰岛素联合3 餐前短效门冬胰岛素控制血糖，将所有患者的空腹血糖控制在7.8 ～ 10.0 mmol/L，并应用动态血糖检测仪每2 ～ 4 h 监测血糖，计算全天血糖的标准差（S），以及最高和最低血糖之差（△）；比较两组患者血清和肺泡灌洗液中炎症因子[ 白细胞介素6（IL-6）、白细胞介素8（IL-8）、肿瘤坏死因子α（TNF-α）]，S、△、空腹血糖达标时间、病死率及低血糖事件情况。结果入院第3 天和第7 天，观察组患者的IL-6、IL-8、TNF-α 下降水平优于对照组（P <0.05）；观察组患者的S 和△低于对照组（t =-4.391 和-4.158，均P =0.000），血糖达标时间优于对照组（t =-10.122，P =0.000）；观察组的28 d 病死率均低于对照组（χ2=4.761，P =0.029）；但是两组低血糖发生率之间的差异无统计学意义（χ2=0.083，P =0.073）；入院时急性生理与慢性健康评分（APACHE Ⅱ）（O^R=2.247）和血糖变异性（O^R=1.449）为死亡的危险因素。结论 对糖尿病并重症肺部感染患者实施胰岛素泵强化血糖控制，可降低全天血糖波动性，缩短血糖达标时间，并可改善炎症反应，利于预后。

Abstract:

Objective To explore the effect of insulin pump intensive treatment on inflammatory factors in serum and bronchoalveolar lavage fluid and diabetes complicated with severe pulmonary infection. Method A total of 172 patients of diabetes complicated with severe pulmonary infection from November 2015 to October 2016 in our hospital were divided randomly into control group (n = 86) and insulin pump intensive treatment group (observation group, n = 86). The patients in the observation group were treated with insulin pump of insulin aspart,and the control group was treated with insulin glargine combined with short-acting insulin aspart. Blood glucose was controlled between 7.8-10.0 mmol/L both in the control group and the observation group. Peripheral blood glucose was checked every 2-4 hours by dynamic blood glucose detector and the standard deviation (S) and the difference between the highest and the lowest blood glucose (Δ) was calculated. The level of inflammatory factors (IL-6, IL-8 and TNF-α) in serum and bronchoalveolar lavage fluid, S, Δ, duration of glycemic controlling, the case fatality rate and the incidence of hypoglycemia were compared between the two groups. Results Levels of IL-6, IL-8 and TNF-α in the observation group decreased significantly more than those of the control group (P < 0.05) on the 3rd and the 7th day after admission to hospital. S and Δ in the observation group was significantly lower than those of the control group (t = -4.391 and -4.158, P = 0.000). Duration of glycemic controlling and the case fatality rate of the 28th day in the observation group were lower than those of the control group (t = -10.122, P = 0.000; χ2 = 4.761, P = 0.029). The incidence of hypoglycemia in the two groups had no statistical difference (χ2 = 0.083, P = 0.073). Logistic regression analysis showed that APACHE II score (O^R= 2.247) and blood glucose variability (O^R= 1.449) were independent riskfactors for mortality. Conclusion Insulin pump intensive treatment can reduce all-day blood glucose fluctuations,shorten duration of glycemic controlling, reduce inflammatory response and improve prognosis in patients with diabetes complicated with severe pulmonary infection.