Nakamura Masataka, Oda Shigeto, Sadahiro Tomohito, Watanabe Eizo, Abe Ryuzo, Nakada Taka-Aki, Morita Yasumasa, Hirasawa Hiroyuki
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo, Chiba-city 2608677, Japan.
Crit Care. 2012 Dec 12;16(2):R58. doi: 10.1186/cc11301.
The aim of the present study was to investigate the relationship between the blood IL-6 level, the blood glucose level, and glucose control in septic patients.
This retrospective observational study in a general ICU of a university hospital included a total of 153 patients with sepsis, severe sepsis, or septic shock who were admitted to the ICU between 2005 and 2010, stayed in the ICU for 7 days or longer, and did not receive steroid therapy prior to or after ICU admission. The severity of stress hyperglycemia, status of glucose control, and correlation between those two factors in these patients were investigated using the blood IL-6 level as an index of hypercytokinemia.
A significant positive correlation between blood IL-6 level and blood glucose level on ICU admission was observed in the overall study population (n = 153; r = 0.24, P = 0.01), and was stronger in the nondiabetic subgroup (n = 112; r = 0.42, P < 0.01). The rate of successful glucose control (blood glucose level < 150 mg/dl maintained for 6 days or longer) decreased with increase in blood IL-6 level on ICU admission (P < 0.01). The blood IL-6 level after ICU admission remained significantly higher and the 60-day survival rate was significantly lower in the failed glucose control group than in the successful glucose control group (P < 0.01 and P < 0.01, respectively).
High blood IL-6 level was correlated with hyperglycemia and with difficulties in glucose control in septic patients. These results suggest the possibility that hypercytokinemia might be involved in the development of hyperglycemia in sepsis, and thereby might affect the success of glucose control.
本研究旨在调查脓毒症患者血液白细胞介素-6（IL-6）水平、血糖水平与血糖控制之间的关系。
这项在一所大学医院综合重症监护病房（ICU）进行的回顾性观察研究，共纳入了153例患有脓毒症、严重脓毒症或脓毒性休克的患者，这些患者于2005年至2010年间入住ICU，在ICU停留7天或更长时间，且在入住ICU之前或之后未接受类固醇治疗。以血液IL-6水平作为高细胞因子血症的指标，研究这些患者应激性高血糖的严重程度、血糖控制状况以及这两个因素之间的相关性。
在整个研究人群（n = 153；r = 0.24，P = 0.01）中，观察到入住ICU时血液IL-6水平与血糖水平之间存在显著正相关，在非糖尿病亚组（n = 112；r = 0.42，P < 0.01）中这种相关性更强。随着入住ICU时血液IL-6水平的升高，血糖控制成功的比率（血糖水平<150 mg/dl维持6天或更长时间）下降（P < 0.01）。血糖控制失败组入住ICU后的血液IL-6水平仍显著高于成功组，且60天生存率显著低于成功组（分别为P < 0.01和P < 0.01）。
血液高IL-6水平与脓毒症患者的高血糖及血糖控制困难相关。这些结果提示高细胞因子血症可能参与脓毒症中高血糖的发生发展，进而可能影响血糖控制的成功率。
