[Changes of insulin receptor in patients with critical illness and hyperglycemia and effect of intensive insulin therapy on it].

OBJECTIVE

To investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it.

METHODS

Nineteen adult patients were admitted to surgical intensive care unit (SICU) and randomly assigned into two groups: intensive glucose controlled group (to control glucose at 4.4-6.7 mmol/L) and hyperglycemia group (to control glucose at 8.3-10.0 mmol/L). Blood glucose was controlled with using continuing insulin infusion. The expression of insulin receptors (InsR) of peripheral erythrocyte was detected by radioligand assay methods on the morning of day 1, 2, 4, 7 after admitted to SICU. Daily usage of insulin and APACHE II score were recorded. The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE II were analyzed.

RESULTS

The number and affinity constant of erythrocyte insulin receptors was decreased significantly in day 1 and 2 in both groups, and recovered gradually in day 4 and 7, and significant difference was found between the patients with APACHE II > or =15 and those with APACHE II < 15. The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hyperglycemia group.

CONCLUSIONS

It indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients, and it plays a role in stress induced hyperglycemia. Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.