Graduate Program in Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, Brazil.
J Clin Endocrinol Metab. 2011 Feb;96(2):478-85. doi: 10.1210/jc.2010-0256. Epub 2010 Nov 17.
CONTEXT/OBJECTIVE: The objective of the study was to evaluate the effects of normalizing glycemia through iv insulin per 24 h on markers of oxidative stress and inflammation in patients with diabetes submitted to percutaneous coronary intervention (PCI) with stent.
PATIENTS/METHODS: This was a prospective, open-label, randomized controlled trial, comparing continuous iv insulin per 24 h targeting glycemia less than 110 mg/dl iv insulin treatment (IIT; n = 35) to standard treatment (ST; n = 35, regular insulin if glycemia was greater than 200 mg/dl). Blood samples for glycemia, glycated hemoglobin, lipids, inflammatory markers [C-reactive protein (CRP), soluble CD40 ligand, IL-6, and endothelin 1 (ET-1)] and oxidative stress (total antioxidant status, carbonyl) were collected immediately after and 24 h after PCI.
Seventy patients were included. Mean age was 60.5 ± 10 yr, 60% were men, glycated hemoglobin was 8.1 ± 1.8 (IIT) vs. 7.6 ± 1.6% (ST) (P = 0.39). The intensive insulin group had lower glycemia (P = 0.006) and higher insulinemia (P < 0.001). Insulin did not change CRP [4.5 (2.1-11.7) vs. 6.8 (2.4-10.3), P = 0.35], soluble CD40 ligand [402 (191-843) vs. 610 (230-1200), P = 0.68], IL-6 [6.21 (3.1.-10.4) vs. 10.37 (5.9-15.3), P = 0.09], and ET-1 [1.02 (0.7-1.8) vs. 1.10 (0.7-1.9), P = 0.657]. CRP, IL-6, and ET-1 increased after PCI in both groups (P < 0.05). No change was observed on protein oxidation (carbonyl, P = 0.70; total antioxidant status, P = 0.33). There was a positive correlation between CRP and glycemia (r = 0.29, P = 0.002).
Continuous iv insulin for 24 h increased insulin levels and prevented hyperglycemia. Insulin infusion did not prevent the rise in inflammatory and oxidative stress markers, and no differences were observed between IIT and ST after PCI with a stent.
背景/目的：本研究的目的是评估 24 小时静脉内胰岛素输注使血糖正常化对接受经皮冠状动脉介入治疗（PCI）伴支架置入的糖尿病患者氧化应激和炎症标志物的影响。
患者/方法：这是一项前瞻性、开放标签、随机对照试验，比较了 24 小时持续静脉内胰岛素输注使血糖目标值<110mg/dl（静脉内胰岛素治疗组，n=35）与标准治疗（ST；n=35，血糖>200mg/dl 时使用常规胰岛素）。在 PCI 后即刻和 24 小时采集血糖、糖化血红蛋白、血脂、炎症标志物[C 反应蛋白（CRP）、可溶性 CD40 配体、IL-6 和内皮素 1（ET-1）]和氧化应激（总抗氧化状态、羰基）的血样。
共纳入 70 例患者。平均年龄为 60.5±10 岁，60%为男性，糖化血红蛋白为 8.1±1.8（IIT 组）vs.7.6±1.6%（ST 组）（P=0.39）。强化胰岛素组血糖较低（P=0.006），胰岛素水平较高（P<0.001）。胰岛素并未改变 CRP[4.5（2.1-11.7）vs.6.8（2.4-10.3），P=0.35]、可溶性 CD40 配体[402（191-843）vs.610（230-1200），P=0.68]、IL-6[6.21（3.1.-10.4）vs.10.37（5.9-15.3），P=0.09]和 ET-1[1.02（0.7-1.8）vs.1.10（0.7-1.9），P=0.657]。两组患者在 PCI 后 CRP、IL-6 和 ET-1 均升高（P<0.05）。未观察到蛋白氧化（羰基，P=0.70；总抗氧化状态，P=0.33）的变化。CRP 与血糖呈正相关（r=0.29，P=0.002）。
24 小时持续静脉内胰岛素输注可升高胰岛素水平并预防高血糖。胰岛素输注并不能预防炎症和氧化应激标志物的升高，在 PCI 伴支架置入后，强化胰岛素治疗与标准治疗之间没有差异。
