The Department of Nosocomiology, The 94th Hospital of PLA, Nanchang, 330002, China.
School of Medicine, Nankai University, Tianjin, 300071, China; Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Sciences, General Hospital of PLA, Beijing 100853, PR China.
Am J Emerg Med. 2018 Feb;36(2):202-207. doi: 10.1016/j.ajem.2017.07.070. Epub 2017 Jul 22.
Insulin, as an anti-inflammatory drug, could not be freely used in patients who experienced trauma according to the degree of inflammation, because of the side effect of hypoglycemia. In vivo experimental evidence is lacking concerning whether the effect is dosage dependent and whether it relies on controlling hyperglycemia.
By adjusting the dosage ratio of glucose and insulin, different dosages of insulin were used to treat severely scalded MODS rats to achieve uncontrolled or controlled hyperglycemia. One hundred forty rats with severe scalded were randomly divided into a hyperglycemia-controlled group, hyperglycemia-uncontrolled group, and control group. The levels of inflammation response indexes and major organ dysfunction indexes were measured and compared between groups.
The blood indexes of inflammatory response and major organ dysfunction did not show statistical difference between hyperglycemia-controlled groups (A) and uncontrolled groups (B) in the same dosage of insulin (all P>0.05). The blood indexes of inflammatory response and major organ dysfunction demonstrated statistical difference in different dosages of insulin with hyperglycemia-controlled groups (A1-A3 groups) and hyperglycemia-uncontrolled groups (B1-B3 groups) (all P<0.01). The higher dosage of insulin, the better effect of anti-inflammation and organ protection it would demonstrate with or without controlling hyperglycemia.
The effect of anti-inflammation and organ protection of insulin is dosage dependent in vivo; it does not rely on controlling hyperglycemia. Temporary traumatic hyperglycemia itself might not be detrimental to the body. Adjusting the ratio of insulin and glucose could provide a novel train of thought for freely treating patients with severe traumatic injury with different dosages of insulin according to the degree of inflammation.
胰岛素作为一种抗炎药物，由于低血糖的副作用，不能根据炎症程度自由用于创伤患者。关于其作用是否具有剂量依赖性以及是否依赖于控制高血糖，体内实验证据不足。
通过调整葡萄糖和胰岛素的剂量比例，用不同剂量的胰岛素治疗严重烫伤 MODS 大鼠，以实现未控制或控制的高血糖。将 140 只严重烫伤的大鼠随机分为高血糖控制组、高血糖未控制组和对照组。测量并比较各组炎症反应指标和主要器官功能障碍指标。
同一剂量胰岛素的高血糖控制组（A 组）和未控制组（B 组）的炎症反应和主要器官功能障碍的血液指标无统计学差异（均 P>0.05）。不同剂量胰岛素的高血糖控制组（A1-A3 组）和高血糖未控制组（B1-B3 组）的炎症反应和主要器官功能障碍的血液指标有统计学差异（均 P<0.01）。胰岛素剂量越高，抗炎和器官保护效果越好，无论是否控制高血糖。
胰岛素的抗炎和器官保护作用在体内具有剂量依赖性，不依赖于控制高血糖。创伤后暂时性高血糖本身可能对机体无害。调整胰岛素和葡萄糖的比例，可以为根据炎症程度自由用不同剂量胰岛素治疗严重创伤患者提供新的思路。
