Chondronikola Maria, Meyer Walter J, Sidossis Labros S, Ojeda Sylvia, Huddleston Joanna, Stevens Pamela, Børsheim Elisabet, Suman Oscar E, Finnerty Celeste C, Herndon David N
From the *Department of Preventative Medicine and Community Health, Graduate School of Biomedical Sciences, University of Texas Medical Branch, Galveston; †Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas; Departments of ‡Psychiatry and ‡Department of Psychiatry, University of Texas Medical Branch, Galveston; §Department of Psychology, Shriners Hospitals for Children, Galveston, Texas; ‖Department of Internal Medicine-Geriatrics, ¶Institute for Translational Sciences, and #Department of Surgery, University of Texas Medical Branch, Galveston; and the **Department of Clinical Research and ††Children's Wellness Center, Shriners Hospitals for Children, Galveston, Texas.
J Burn Care Res. 2014 Sep-Oct;35(5):409-15. doi: 10.1097/BCR.0000000000000017.
Burn injury is a dramatic event with acute and chronic consequences including insulin resistance. However, factors associated with insulin resistance have not been previously investigated. The purpose of this study was to identify factors associated with long-term insulin resistance in pediatric burn injury survivors. The study sample consisted of 61 pediatric burn injury survivors 24 to 36 months after the burn injury, who underwent an oral glucose tolerance test. To assess insulin resistance, the authors calculated the area under the curve for glucose and insulin. The diagnostic criteria of the American Diabetes Association were used to define individuals with impaired glucose metabolism. Additional data collected include body composition, anthropometric measurements, burn characteristics, and demographic information. The data were analyzed using multivariate linear regression analysis. Approximately 12% of the patients met the criteria for impaired glucose metabolism. After adjusting for possible confounders, burn size, age, and body fat percentage were associated with the area under the curve for glucose (P < .05 for all). Time postburn and lean mass were inversely associated with the area under the curve for glucose (P < .05 for both). Similarly, older age predicted higher insulin area under the curve. The results indicate that a significant proportion of pediatric injury survivors suffer from glucose abnormalities 24 to 36 months postburn. Burn size, time postburn, age, lean mass, and adiposity are significant predictors of insulin resistance in pediatric burn injury survivors. Clinical evaluation and screening for abnormal glucose metabolism should be emphasized in patients with large burns, older age, and survivors with high body fat.
烧伤是一种具有急性和慢性后果（包括胰岛素抵抗）的重大事件。然而，此前尚未对与胰岛素抵抗相关的因素进行研究。本研究的目的是确定小儿烧伤幸存者长期胰岛素抵抗的相关因素。研究样本包括61名烧伤后24至36个月的小儿烧伤幸存者，他们接受了口服葡萄糖耐量试验。为评估胰岛素抵抗，作者计算了葡萄糖和胰岛素的曲线下面积。采用美国糖尿病协会的诊断标准来定义糖代谢受损个体。收集的其他数据包括身体成分、人体测量数据、烧伤特征和人口统计学信息。使用多元线性回归分析对数据进行分析。约12%的患者符合糖代谢受损标准。在对可能的混杂因素进行校正后，烧伤面积、年龄和体脂百分比与葡萄糖曲线下面积相关（均P <.05）。烧伤后时间和瘦体重与葡萄糖曲线下面积呈负相关（均P <.05）。同样，年龄较大预示着胰岛素曲线下面积较高。结果表明，相当比例的小儿烧伤幸存者在烧伤后24至36个月存在糖代谢异常。烧伤面积、烧伤后时间、年龄、瘦体重和肥胖是小儿烧伤幸存者胰岛素抵抗的重要预测因素。对于大面积烧伤、年龄较大以及体脂较高的幸存者，应强调对糖代谢异常进行临床评估和筛查。
