Effect of Intensive Insulin Therapy on Inflammatory Level of Biliary Pyemia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PU Changchun , ZHOU Xigui , HU Jieliang , LI Faping

*Department of General Surgery of Baiyin Municipal First People’s Hospital, Baiyin 730900, Gansu Province, China;

Corresponding author：

Keywords：

Intensive insulin; Biliary pyemia; Cytokine; C-reactive protein; APACHE Ⅱ score

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the possible anti-inflammatory mechanism of intensive insulin therapy （IIT） by studying the effect of IIT on the levels of TNF-α, IL-6, C-reactive protein （CRP） and APACHE Ⅱ score in biliary pyemia. Methods Twenty eight patients with biliary pyemia who were admitted by our department and given an operation within 24 h form Jan. 2005 to Dec. 2008 were randomly divided into two groups by using random number table numbers: one group treated with IIT （IIT group, n=14） and another group treated with routine insulin therapy （RIT group, n=14）. The inflammatory factors, such as TNF-α, IL-6 and CRP were detected dynamically and the APACHEⅡ score was calculated. ResultsThe level of CRP and APACHEⅡ score on day 5 and 7 and the levels of TNF-α and IL-6 on day 3, 5 and 7 after operation in IIT group were significantly lower than those in RIT group （P＜0.05, P＜0.0１）. Compared with preoperative levels, the IL-6 and APACHEⅡ score in IIT group commenced to decrease on day 3 after operation （P＜0.05）, that was earlier than control group. Conclusion The treatment with IIT can suppress the composition of TNF-α, IL-6 and CRP, protect impaired hepatic cells, and reduce APACHEⅡ score, the degree of systemic inflammation and incidence of MODS.

Citation： PU Changchun,ZHOU Xigui,HU Jieliang,LI Faping. Effect of Intensive Insulin Therapy on Inflammatory Level of Biliary Pyemia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(12): 974-977. doi: Copy

1.	van den Berghe G, Wouters P, Weekers F, et al. Ineensive insulin therapy in criticaiiy ill patients [Ｊ]. N Eng J Med, 2001； 345（19）: 1359-1367.
2.	Das UN. Insulin and Inflammation: further evidence and discussion [Ｊ]. Nutrition, 2002； 18（6）: 526-527.
3.	Hirsch IB. Effect of insulin therapy on nonglycemic variables during acute illness [Ｊ]. Endocr Pract, 2004； 10（Suppl 2）: 63-70.
4.	Jeschke MG, Einspanier R, Klein D, et al. Insulin attenuates the systemic inflammatory response to thermal trauma [Ｊ]. Mol Med, 2002； 8（8）: 443-450.
5.	黄志强，董家鸿，王敖川，等. 胆源性脓毒症对肝脏线粒体呼吸功能的影响 [Ｊ]. 中国普外基础与临床杂志, 2000； 7（2）： 66-68.
6.	黄志强主编. 黄志强胆道外科 [M]. 第1版. 济南：山东科学技术出版社， 2000： 228-230.
7.	Robinson LE, van Soeren MH. Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control [Ｊ]. AACN Clin Issues, 2004; 15(1): 45-62.
8.	Steve W. The role of mediators in sepsis resolution. Advan-ces in sepsis [Ｊ]. 2002; 2(1): 8-14.
9.	Cheung NW, Napier B, Zaccaria C, et al. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition [J]. Diabetes Care, 2005； 28(10): 2367-2371.
10.	Krinsley JS. Association between hyperglycemia and increas-ed hospital mortality in a heterogeneous population of crically inn patients [J]. Mayo Clin Proc, 2003； 78(12): 1471-1478.
11.	姚永明，孟海东. 脓毒症高血糖与胰岛素强化治疗策略 [J]. 中国危重病急救医学杂志， 2006； 18(2): 68-70.
12.	Hansen TK, Thiel S, Wouters PJ, et al. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels [J]. J Clin Endocrinol Metab， 2003; 88(3): 1082-1088.
13.	Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? [J]. J Clin Invest, 2004；114（9）: 1187-1195.
14.	Weekrs F, Giulietti AP, Michalaki M, et al. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness[J]. Endocrinology, 2003; 144(12): 5329-5338.
15.	董家鸿，韩本立，李昆，等. 地塞米松改变胆源性脓毒症时宿主糖代谢反应 [J]. 普外基础与临床杂志， 1994； 1（1）： 15-18.
16.	孙文斌，马瑞亮，韩本立，等. 大鼠胆源性脓毒症时肝脏糖异生功能及相关激素环境的改变 [J]. 中国普外基础与临床杂志， 1997； 4（3）： 135-138.
17.	Angus DC, Abraham E. Inrensive insulin therpy in critical illness [Ｊ]. Am J Respir Crit Care Med, 2005； 172(11): 1358-1359.
18.	Finney SJ, Zekveld C, Elia A, et al. Glucose control and mortality in critically ill patients [Ｊ]. JAMA, 2003； 290（15）: 2041-2047.
19.	李斌，李玉明，李迅，等. 环氧合酶-2对脓毒症大鼠肝损伤的影响 [J]. 中国普外基础与临床杂志， 2008； 15（4）： 266-270.
20.	钱建中，潘奎. 肿瘤坏死因子在梗阻性黄疸鼠肝损伤中的作用 [J]. 腹部外科杂志， 1999； 12（5）： 229-231.
21.	贾士勇，黄志强，孟宪钧. 肿瘤坏死因子在梗阻性黄疸鼠肝中的免疫组化分析 [J]. 中华实验外科杂志， 1995； 12（4）： 197-198.
22.	董家鸿，黄志强，王傲川，等. 实验性胆源性脓毒症时肝脏代谢反应及其调控机制的改变 [J]. 第三军医大学学报， 1994； 16（1）： 4.
23.	Viss R, Nagase H. Matrix metalloproteinases and tissue inhibitors of metalloproteinuses: strueture, function, and biochemistry [Ｊ]. Circ Res, 2003； 92 (8): 827-839.
24.	石田孝雄，三岛好雄. 急性化脓性胆管炎の治疗と予后，死亡例の检讨予后决定因子にっぃこ [Ｊ]. 胆と， 1995； 16（7）： 597-601.
25.	De Maio A, Mooney ML, Matesic LE, et al. Genetic component in the inflammatory response induced by bacterial lipopolysaccharide [Ｊ]. Shock, 1998； 10(5): 319-323.

1. van den Berghe G, Wouters P, Weekers F, et al. Ineensive insulin therapy in criticaiiy ill patients [Ｊ]. N Eng J Med, 2001； 345（19）: 1359-1367.
2. Das UN. Insulin and Inflammation: further evidence and discussion [Ｊ]. Nutrition, 2002； 18（6）: 526-527.
3. Hirsch IB. Effect of insulin therapy on nonglycemic variables during acute illness [Ｊ]. Endocr Pract, 2004； 10（Suppl 2）: 63-70.
4. Jeschke MG, Einspanier R, Klein D, et al. Insulin attenuates the systemic inflammatory response to thermal trauma [Ｊ]. Mol Med, 2002； 8（8）: 443-450.
5. 黄志强，董家鸿，王敖川，等. 胆源性脓毒症对肝脏线粒体呼吸功能的影响 [Ｊ]. 中国普外基础与临床杂志, 2000； 7（2）： 66-68.
6. 黄志强主编. 黄志强胆道外科 [M]. 第1版. 济南：山东科学技术出版社， 2000： 228-230.
7. Robinson LE, van Soeren MH. Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control [Ｊ]. AACN Clin Issues, 2004; 15(1): 45-62.
8. Steve W. The role of mediators in sepsis resolution. Advan-ces in sepsis [Ｊ]. 2002; 2(1): 8-14.
9. Cheung NW, Napier B, Zaccaria C, et al. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition [J]. Diabetes Care, 2005； 28(10): 2367-2371.
10. Krinsley JS. Association between hyperglycemia and increas-ed hospital mortality in a heterogeneous population of crically inn patients [J]. Mayo Clin Proc, 2003； 78(12): 1471-1478.
11. 姚永明，孟海东. 脓毒症高血糖与胰岛素强化治疗策略 [J]. 中国危重病急救医学杂志， 2006； 18(2): 68-70.
12. Hansen TK, Thiel S, Wouters PJ, et al. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels [J]. J Clin Endocrinol Metab， 2003; 88(3): 1082-1088.
13. Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? [J]. J Clin Invest, 2004；114（9）: 1187-1195.
14. Weekrs F, Giulietti AP, Michalaki M, et al. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness[J]. Endocrinology, 2003; 144(12): 5329-5338.
15. 董家鸿，韩本立，李昆，等. 地塞米松改变胆源性脓毒症时宿主糖代谢反应 [J]. 普外基础与临床杂志， 1994； 1（1）： 15-18.
16. 孙文斌，马瑞亮，韩本立，等. 大鼠胆源性脓毒症时肝脏糖异生功能及相关激素环境的改变 [J]. 中国普外基础与临床杂志， 1997； 4（3）： 135-138.
17. Angus DC, Abraham E. Inrensive insulin therpy in critical illness [Ｊ]. Am J Respir Crit Care Med, 2005； 172(11): 1358-1359.
18. Finney SJ, Zekveld C, Elia A, et al. Glucose control and mortality in critically ill patients [Ｊ]. JAMA, 2003； 290（15）: 2041-2047.
19. 李斌，李玉明，李迅，等. 环氧合酶-2对脓毒症大鼠肝损伤的影响 [J]. 中国普外基础与临床杂志， 2008； 15（4）： 266-270.
20. 钱建中，潘奎. 肿瘤坏死因子在梗阻性黄疸鼠肝损伤中的作用 [J]. 腹部外科杂志， 1999； 12（5）： 229-231.
21. 贾士勇，黄志强，孟宪钧. 肿瘤坏死因子在梗阻性黄疸鼠肝中的免疫组化分析 [J]. 中华实验外科杂志， 1995； 12（4）： 197-198.
22. 董家鸿，黄志强，王傲川，等. 实验性胆源性脓毒症时肝脏代谢反应及其调控机制的改变 [J]. 第三军医大学学报， 1994； 16（1）： 4.
23. Viss R, Nagase H. Matrix metalloproteinases and tissue inhibitors of metalloproteinuses: strueture, function, and biochemistry [Ｊ]. Circ Res, 2003； 92 (8): 827-839.
24. 石田孝雄，三岛好雄. 急性化脓性胆管炎の治疗と予后，死亡例の检讨予后决定因子にっぃこ [Ｊ]. 胆と， 1995； 16（7）： 597-601.
25. De Maio A, Mooney ML, Matesic LE, et al. Genetic component in the inflammatory response induced by bacterial lipopolysaccharide [Ｊ]. Shock, 1998； 10(5): 319-323.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Intensive Insulin Therapy on Inflammatory Level of Biliary Pyemia

Abstract Full text Figures/Tables Video References Cited by

Format

Content