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Objective To investigate glycemic control,changes of inflammatory factors and their clinical significance in severe sepsis patients.Methods One hundred and three severe sepsis patients with abnormal hyperglycemia were randomly divided into the two groups and receive intensive insulin therapy (IIT) and conventional insulin therapy (CIT) respectively.According to glycosylated hemoglobin level,the two groups were further divided into stress hyperglycaemia and diabetes mellitus subgroups.The mortality and incidence of hypoglycemia were compared between the groups and subgroups.Enzyme linked immunosorbent assay was used to detect TNF-α,IL-6 levels before treatment,3 and 7 days after treatment.Results In IIT group,the mortality in diabetes mellitus subgroup was significantly higher than that in stress hyperglycaemia subgroup (66.7％ vs.30.8％,P ＜ 0.05),while the mortality in stress hyperglycaemia subgroup significantly higher than that in diabetes mellitus subgroup (54.1％ vs.25.0％,P ＜ 0.05) in CIT group.Multivariate Logistic regression analysis revealed IIT increased the risk for death in diabetes mellitus subgroup (OR =1.221,95％ CI:1.075-1.434),while decreased the risk for death in stress hyperglycaemia subgroup (OR =0.872,95％ CI:0.714-0.975).The incidence of hypoglycemia was significantly higher in IIT group than that in CIT group (13.7％ vs.1.9％,P ＜0.05).Before treatment,the levels of TNF-α,IL-6 in stress hyperglycaemia patients were significantly higher than those in diabetes mellitus patients.After 7 day treatment,The levels of TNF-α,IL-6 decreased significantly in stress hyperglycaemia patients (P ＜ 0.01),and decreased more significantly in IIT group than that in CIT group.Conclusion Severe sepsis patients with stress hyperglycaemia can attain better glycemia control and inhibition of inflammatory factors,and clinical benefit from IIT.
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OBJECTIVE: To assess the effect of intensive insulin therapy on outcomes of patients with severe acute pancreatitis. METHODS: Relevant literatures cited in these electronic databases: Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) database, and Excerpta Medical database (Embase) were systematically searched for randomized controlled trials (RCTs) in which intensive insulin therapy was used in severe acute pancreatitis. Length of hospitalization, acute physiology and chronic health evaluation II (APACHE II) score, incidence of complications, and adverse effects were recorded for statistical analysis. The methodological quality of the eligible studies was assessed by Jadad scale. The results were analysed by Revman 4.3 software. RESULTS: Three studies, which included a total of 118 cases, were finally reviewed. The methodological quality of the trials varied substantially. In patients with severe acute pancreatitis, intensive insulin therapy was associated with shorter length of hospitalization (weighted mean difference (WMD) = -12.13, 95% confidence interval (CI) [-15.48,8.78], p > 0.00001) and lower APACHE II score after 72 hours treatment (WMD = -3.80, 95% CI [-4.88,2.72], p> 0.00001). One study reported insulin-related adverse event. CONCLUSION: In patients with severe acute pancreatitis, intensive insulin therapy could relieve the patient's condition earlier and shorten the length of hospitalization without serious adverse effect.
OBJETIVO: Evaluar el efecto de la terapia intensiva de insulina en la evolución clínica de los pacientes afligidos de pancreatitis aguda severa. MÉTODOS: La literatura pertinente citada a partir de las siguientes bases electrónicas de datos: Medline, Base de datos de literatura biomédica china, Base de datos de la infraestructura nacional china de conocimientos (CNKI), y la Excerpta Medical Database (Embase). Todas estas bases de datos fueron investigadas sistemáticamente en busca ensayos controlados aleatorios (RCT), en los cuales la terapia de insulina intensiva se usó en la pancreatitis aguda severa. El tiempo de hospitalización, la fisiología aguda, y la puntuación de la evaluación de salud crónica II (APACHE II), la incidencia de complicaciones, así como los efectos adversos, fueron registrados para el análisis estadístico. La calidad metodológica de los estudios elegibles fue evaluada mediante la escala de Jadad. Los resultados se analizaron mediante el software Revman 4.3. RESULTADOS: Finalmente se examinaron tres estudios que incluyeron un total de 118 casos. La calidad metodológica de los ensayos varió sustancialmente. En los pacientes con pancreatitis aguda severa, la terapia de insulina intensiva estuvo asociada con una estadía hospitalaria más corta (diferencia media ponderada WMD = -12.13, 95% intervalo de confianza (CI) [-15.48, 8.78], p < 0.00001) y una puntuación APACHE II más baja después de 72 horas de tratamiento (WMD = -3.80, 95% CI [-4.88, 2.72], p < 0.00001). Un estudio reportó eventos adversos relacionados con la insulina. CONCLUSIÓN: En los pacientes con pancreatitis aguda severa, la terapia intensiva de insulina podría aliviar la condición del paciente más rápidamente, y acortar el tiempo de hospitalización sin serios efectos adversos.