Changes of insulin receptor in patients with critical illness and hyperglycemia and effect of intensive insulin therapy on it / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it.</p><p><b>METHODS</b>Nineteen adult patients were admitted to surgical intensive care unit (SICU) and randomly assigned into two groups: intensive glucose controlled group (to control glucose at 4.4-6.7 mmol/L) and hyperglycemia group (to control glucose at 8.3-10.0 mmol/L). Blood glucose was controlled with using continuing insulin infusion. The expression of insulin receptors (InsR) of peripheral erythrocyte was detected by radioligand assay methods on the morning of day 1, 2, 4, 7 after admitted to SICU. Daily usage of insulin and APACHE II score were recorded. The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE II were analyzed.</p><p><b>RESULTS</b>The number and affinity constant of erythrocyte insulin receptors was decreased significantly in day 1 and 2 in both groups, and recovered gradually in day 4 and 7, and significant difference was found between the patients with APACHE II > or =15 and those with APACHE II < 15. The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hyperglycemia group.</p><p><b>CONCLUSIONS</b>It indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients, and it plays a role in stress induced hyperglycemia. Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.</p>

Impact of intensive insulin therapy on surgical critically ill patients / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU).</p><p><b>METHODS</b>One hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cell transfusion, hospital mortality and ICU cost.</p><p><b>RESULTS</b>Compared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cell transfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05).</p><p><b>CONCLUSIONS</b>To maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.</p>