Heuer Josef G, Sharma Ganesh R, Zhang Tonghai, Ding Chunjin, Bailey Dianna L, Stephens Eddie J, Holmes Kimberly C, Grubbs Renee L, Fynboe Kelly A, Chen Yun-Fei, Jakubowski Joseph A
Biotechnology Discovery Research Division, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA.
J Trauma. 2006 Apr;60(4):865-72. doi: 10.1097/01.ta.0000215565.29846.ab.
The effects of hyperglycemia and insulin therapy on septic outcome have not been well studied.
Septic hyperglycemia was induced by infusion of TPN (254 kcal/kg x d) immediately following cecal ligation and puncture (CLP) surgery in rats. Animals (N = 109) were monitored for blood glucose and followed for survival for 4 days. Separate cohorts (N = 36) were sacrificed at 22 hours post-CLP and analyzed for cytokines/chemokines, hormones, and organ damage markers. The effects of insulin treatment on 4 day survival were also examined (N = 60).
Hyperglycemic septic animals had significantly higher blood glucose (p < 0.0001), plasma proinflammatory cytokine levels, serum organ damage markers (p < 0.05) and reduced mean survival time (p < 0.001). Insulin treatment (2 IU/kg/hr) resulted in significantly lower blood glucose (p < 0.01) and improved 4 day survival (p < 0.03).
Hyperglycemia is associated with greater morbidity and mortality in sepsis. Insulin therapy significantly improved survival suggesting that management of hyperglycemia with insulin may improve outcome in septic patients.
高血糖和胰岛素治疗对脓毒症结局的影响尚未得到充分研究。
在大鼠盲肠结扎和穿刺（CLP）手术后立即输注全胃肠外营养（TPN，254千卡/千克×天）诱导脓毒症性高血糖。监测动物（N = 109）的血糖，并跟踪其4天的生存情况。在CLP术后22小时处死另一组动物（N = 36），分析细胞因子/趋化因子、激素和器官损伤标志物。还研究了胰岛素治疗对4天生存率的影响（N = 60）。
高血糖脓毒症动物的血糖显著更高（p < 0.0001）、血浆促炎细胞因子水平、血清器官损伤标志物（p < 0.05），平均生存时间缩短（p < 0.001）。胰岛素治疗（2国际单位/千克/小时）导致血糖显著降低（p < 0.01），并改善了4天生存率（p < 0.03）。
高血糖与脓毒症中更高的发病率和死亡率相关。胰岛素治疗显著提高了生存率，表明用胰岛素控制高血糖可能改善脓毒症患者的结局。
