ABSTRACT
Objective@#To investigate the effect of intensive insulin therapy on the immune function and prognosis of severe thoracic injuries patients with stress hyperglycemia.@*Methods@#A retrospective case control study was performed to analyze the clinical data of 60 patients with severe chest trauma and stress-induced hyperglycemia admitted to Chongqing People's Hospital from October 2016 to October 2018. There were 31 males and 26 females, aged 25-61 years [(46.1±4.0)years]. The abbreviated injury scale (AIS) range was 3-5 points. Thirty patients received routine insulin therapy (routine treatment group) and thirty patients received intensive insulin therapy (intensive treatment group). Venous blood was collected from two groups of patients before treatment, 1 day, 3 days, 5 days and 7 days after treatment respectively. Level of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP)], and lymphocyte count (CD14＋, CD4＋ and CD4＋/CD8＋) were detected respectively. The incidence of nosocomial infection, length of hospital stay, mortality and incidence of hypoglycemia were compared between the two groups.@*Results@#There were no significant differences in plasma TNF-α, IL-6 and CRP levels between the two groups before treatment (P>0.05). After treatment (1-7 days), the levels of serum TNF-α, IL-6 and CRP in the intensive treatment group were lower than those of routine treatment group (P<0.05 or 0.01). Compared with these before treatment, the levels of TNF-α, IL-6 and CRP in both groups increased to varied degrees, reaching a peak on day 3, followed by a gradual decline (P<0.05 or 0.01). There were no statistically significant differences in CD14＋, CD4＋、CD4＋/CD8＋ lymphocyte counts between the two groups before treatment (P>0.05). On days 3, 5, and 7 after treatment, the counts of CD14＋ lymphocytes [3 d: (0.61±0.08)×109 vs. (0.55±0.09)×109, 5 d: (0.68±0.05)×109 vs. (0.63±0.05)×109, 7 d: (0.77±0.07)×109 vs. (0.71±0.06)×109], CD4＋ lymphocytes [3 d: (0.29±0.04)×109 vs. (0.25±0.03)×109, 5 d: (0.32±0.04)×109 vs. (0.30±0.05)×109, 7 d: (0.34±0.03)×109 vs. (0.32±0.06)×109], CD4＋/CD8＋ lymphocytes [3 d: (0.28±0.04)×109 vs. (0.26±0.06)×109, 5 d: (0.33±0.03)×109 vs. (0.31±0.06)×109, 7 d: (0.35±0.03)×109 vs. (0.32±0.06)×109] in the intensive treatment group were higher than those in the routine treatment group. Compared with before treatment, the counts of CD14+ , CD4+ , CD4+ /CD8+ lymphocytes in the two groups were raised to different degrees after treatment for 3 days, with significant differences (P<0.05 or 0.01). Compared with routine treatment group, patients in intensive treatment group had lower incidence of nosocomial infection [57%(17/30) vs. 30%(9/30)], shorter duration of mechanical ventilation [(12.8±2.4)vs. (7.4±1.2)days], and lower hospital mortality rate [27%(8/30) vs. 10%(3/30)]. There was no significant difference in the incidence of hypoglycemia between the two groups(P>0.05).@*Conclusion@#For severe chest trauma patients with stress hyperglycemia, intensive insulin therapy can effectively improve the immunity, inhibit the inflammatory reaction, reduce the complication incidence, restore ventilation function and improve survival rate.
ABSTRACT
Objective To investigate the effect of intensive insulin therapy on the immune function and prognosis of severe thoracic injuries patients with stress hyperglycemia.Methods A retrospective case control study was performed to analyze the clinical data of 60 patients with severe chest trauma and stress-induced hyperglycemia admitted to Chongqing People's Hospital from October 2016 to October 2018.There were 31 males and 26 females,aged 25-61 years [(46.1 ± 4.0)years].The abbreviated injury scale (AIS) range was 3-5 points.Thirty patients received routine insulin therapy (routine treatment group) and thirty patients received intensive insulin therapy (intensive treatment group).Venous blood was collected from two groups of patients before treatment,1 day,3 days,5 days and 7 days after treatment respectively.Level of inflammatory cytokines [tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and C-reactive protein (CRP)],and lymphocyte count (CD14 +,CD4 +and CD4 +/CD8 +) were detected respectively.The incidence of nosocomial infection,length of hospital stay,mortality and incidence of hypoglycemia were compared between the two groups.Results There were no significant differences in plasma TNF-α,IL-6 and CRP levels between the two groups before treatment (P ＞ 0.05).After treatment (1-7 days),the levels of serum TNF-α,IL-6 and CRP in the intensive treatment group were lower than those of routine treatment group (P ＜ 0.05 or 0.01).Compared with these before treatment,the levels of TNF-α,IL-6 and CRP in both groups increased to varied degrees,reaching a peak on day 3,followed by a gradual decline (P ＜ 0.05 or 0.01).There were no statistically significant differences in CD14 +,CD4 + 、CD4 +/CD8 + lymphocyte counts between the two groups before treatment (P ＞ 0.05).On days 3,5,and 7 after treatment,the counts of CD14+ lymphocytes [3 d:(0.61 ±0.08) × 109 vs.(0.55 ±0.09) × 109,5 d:(0.68 ±0.05) × 109 vs.(0.63±0.05) ×109,7 d:(0.77±0.07) ×109 vs.(0.71±0.06) ×109],CD4 + lymphocytes [3 d:(0.29 ±0.04) × 109 vs.(0.25 ±0.03) × 109,5 d:(0.32 ±0.04) × 109 vs.(0.30 ±0.05) × 109,7 d:(0.34±0.03) ×109 vs.(0.32±0.06) ×109],CD4 +/CD8+ lymphocytes [3 d:(0.28 ±0.04) ×109 vs.(0.26 ±0.06) × 109,5 d:(0.33 ±0.03) × 109 vs.(0.31 ±0.06) × 109,7 d:(0.35 ±0.03) × 109 vs.(0.32 ± 0.06) × 109] in the intensive treatment group were higher than those in the routine treatment group.Compared with before treatment,the counts of CD14 +,CD4 +,CD4 +/CD8 + lymphocytes in the two groups were raised to different degrees after treatment for 3 days,with significant differences (P ＜0.05 or 0.01).Compared with routine treatment group,patients in intensive treatment group had lower incidence of nosocomial infection [57％ (17/30) vs.30％ (9/30)],shorter duration of mechanical ventilation [(12.8 ± 2.4) vs.(7.4 ± 1.2) days],and lower hospital mortality rate [27％ (8/30) vs.10％ (3/30)].There was no significant difference in the incidence of hypoglycemia between the two groups(P ＞ 0.05).Conclusion For severe chest trauma patients with stress hyperglycemia,intensive insulin therapy can effectively improve the immunity,inhibit the inflammatory reaction,reduce the complication incidence,restore ventilation function and improve survival rate.