强化胰岛素治疗对重症感染患者淋巴细胞亚群及降钙素原的动态变化和意义

目的探讨强化胰岛素治疗对重症感染患者淋巴细胞亚群及降钙素原的动态影响和意义。方法将50例重症感染患者分为强化胰岛素治疗组（控制血糖在4.4～6.1 mmol/L）和常规治疗组（控制血糖在10.0～11.1 mmol/L）,观察两组患者治疗前后淋巴细胞亚群、降钙素原（PCT）水平以及预后情况。结果两组治疗后血清PCT水平、APACHEⅡ评分和SOFA评分差异均有统计学意义（均〈0.05）。强化胰岛素治疗组治疗前后外周血CD3^＋、CD4^＋、CD4^＋/CD8^＋比值差异均有统计学意义（均〈0.05）;常规治疗组治疗期间外周血CD3^＋、CD4^＋、CD4^＋/CD8^＋与同期检测的强化胰岛素治疗组相比,差异亦有统计学意义（均〈0.05）,且与疾病预后存在一定关联。讨论强化胰岛素治疗重症感染可降低病死率,改善预后;同时淋巴细胞亚群联合PCT检测可以作为其治疗过程中疾病严重程度及预后的指标。

The alteration and significance of intensive insulin therapy on peripheral T-lymphocyte subpopulations and serum procalcitonin in patients with severe sepsis

Objective To assess the alteration and significance of intensive insulin therapy（IIT） on peripheral T-lymphocyte subpopulations and serum Procalcitonin（PCT） in patients with severe sepsis.Methods 50 patients with severe sepsis were randomly divided into 2 groups.Intensive insulin therapy group was treated with tight control of blood glucose by intensive insulin therapy（maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L）,and the other one was treated with conventional treatment（maintenance of blood glucose at a level between 10.0 and 11.1 mmol/L）.Peripheral T-lymphocyte subpopulations,serum Procalcitonin,acute physiology an chronic health evaluation II（APACHE II） scores and sequential organ failure assessment（SOFA）scores were measured before and after 7 days and 14 days therapy in each group.Results The level of PCT and the scores of APACHE II and SOFA were significantly different in two groups（ P〈0.05）.The values of CD3^ ＋,CD4 ^＋ and CD4 ^＋/ CD8^ ＋ were higher in the IIT treatment group after 7 days and 14 days therapy（P〈 0.05）.Compared with the IIT treatment group,the valus of CD3 ^＋,CD4^ ＋ and CD4^ ＋/ CD8^ ＋ were significantly lower in the conventional treatment group after 7 days and 14 days therapy（P 〈0.05）,and it is related with the prognosis.Conclusions For severe sepsis,tight control of blood glucose by IIT therapy can reduce the fatality rate and improve prognosis;besides,T-lymphocyte subpopulations and PCT can be used as the indicators of the severity and prognosis.