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目的通过胰岛素强化治疗对严重创伤患者CD14+单核细胞比率及CD14+单核细胞人白细胞抗原-DR(HLA-DR)表达的影响,探讨强化治疗在严重创伤后的抗炎与免疫调节作用的效果和临床价值。方法采用随机配对分组的研究方法,对外科ICU收治的损伤严重程度评分(ISS)>20分的严重创伤患者分别给予胰岛素强化治疗(血糖目标值6~8mmol/L)和常规治疗(血糖目标值<11.1 mmol/L)。分别在入院后0、2、4、6、8 d留取外周静脉血,采用流式细胞技术检测CD14+单核细胞HLA-DR表达率。结果胰岛素强化治疗组随着强化治疗时间增加,CD14+单核细胞HLA-DR表达下降,具有统计学意义(P<0.05或P<0.01);与常规治疗组相比较,胰岛素强化治疗在不同时间点对CD14+单核细胞比率无明显影响(P>0.05)。结论胰岛素强化治疗在控制创伤后应激性血糖升高的同时,保护了伤后脏器功能,增强天然免疫防御反应的同时,也有诱导创伤后免疫抑制的风险。在严重创伤早期实施有选择性和适度的胰岛素强化治疗对危重患者更为可取。
Objective To investigate the effect of intensive treatment on the anti-inflammatory and immunoregulatory effects of severe trauma and the effect of intensive insulin therapy on the expression of CD14 + monocyte and CD14 + monocyte leukemia antigen-DR (HLA-DR) Clinical Value. Methods A randomized matched grouping study was conducted to evaluate the effects of intensive insulin therapy (target blood glucose level 6 ~ 8mmol / L) and routine treatment (target blood glucose level) on severe traumatic patients with injury severity score (ISS)> 20 in surgical ICU <11.1 mmol / L). Peripheral venous blood was collected at 0, 2, 4, 6 and 8 days after admission, and the expression of HLA-DR of CD14 + monocytes was detected by flow cytometry. Results Compared with the conventional treatment group, the intensive insulin treatment showed that the expression of HLA-DR of CD14 + monocytes decreased with the increase of intensive treatment time (P <0.05 or P <0.01). At different time points No significant effect on the ratio of CD14 + monocytes (P> 0.05). Conclusions Insulin fortification therapy can protect the post-traumatic organ function, enhance the innate immune defense response and at the same time induce the risk of posttraumatic immunosuppression while controlling the post-traumatic stress hyperglycemia. It is preferable to critically ill patients to have selective and moderate intensive insulin therapy in the early stages of severe trauma.