Department of Intensive Care Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium.
Best Pract Res Clin Anaesthesiol. 2009 Dec;23(4):449-59. doi: 10.1016/j.bpa.2009.08.008.
High blood glucose levels have been associated with morbidity and poor outcome in critically ill patients, irrespective of underlying pathology. In a large, randomised, controlled study the use of insulin therapy to maintain normoglycaemia for at least a few days improved survival and reduced morbidity of patients who are in a surgical intensive care unit (ICU). Since the publication of this landmark study, several other investigators have provided support for, whereas others have questioned, the beneficial effects of intensive insulin therapy. In this review, we discuss the investigated potential molecular mechanisms behind the clinical benefits of intensive insulin therapy. We first describe the molecular origin of hyperglycaemia and the impact of the therapy on insulin sensitivity. Next, the molecular basis of glucose toxicity in critical illness and the impact of intensive insulin therapy hereon are described, as well as other non-glucose-toxicity-related metabolic effects of intensive insulin therapy.
高血糖水平与危重病患者的发病率和不良预后相关，无论其潜在病理如何。在一项大型、随机、对照研究中，使用胰岛素治疗将血糖维持在正常范围内至少几天，可改善入住外科重症监护病房（ICU）患者的生存率并降低发病率。自这项具有里程碑意义的研究发表以来，其他几位研究人员提供了支持强化胰岛素治疗有益效果的证据，而其他一些人则对此提出了质疑。在这篇综述中，我们讨论了强化胰岛素治疗临床获益的潜在分子机制。我们首先描述了高血糖的分子起源以及治疗对胰岛素敏感性的影响。接下来，我们描述了危重病中葡萄糖毒性的分子基础以及强化胰岛素治疗对此的影响，以及强化胰岛素治疗的其他非葡萄糖毒性相关代谢作用。
