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.
ObjectiveTo compare the value of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores, the pneumonia severity index (PSI) scores), the CURB-65 scores, and serum procalcitonin (PCT) concentration in prediction of prognosis for inpatients with community-acquired pneumonia (CAP) and discuss the influence factors.MethodsRetrospective analysis was conducted based on the APACHEⅡ scores, the CURB-65 scores, the PSI scores and PCT concentration of hospitalized CAP patients admitted in the Department of Respiratory Medicine of First Hospital of Shanxi Medical University between January 2015 and December 2016, and within 24 hours of their admission. The end point of this study was the clinical outcome of hospitalization (recovery, improvement, exacerbation or death). Receiver operating characteristic (ROC) curve analysis and binary logistic regression models were used to assess the ability of prognostic evaluation and determine the boundary value, to screen risk factors that influence deterioration and death in CAP patients.ResultsTwo hundred and thirty-five CAP patients were enrolled with 146 males and 89 females at an average age of (60.4±18.1) years old. All patients were divided into 2 groups: improving recovery group had 205 cases, and deteriorating group had 30 cases. The rank of areas under the ROC curve for predicting the deterioration and death risk of CAP, from big to small were APACHEⅡ(0.889), PSI (0.850), CURB-65 (0.789), and PCT (0.720). APACHEⅡ score over 11 points and PSI score over 91 points were optimal cut-off values for the prognostic assessment. Moreover, the logistic regression analysis revealed that APACHEⅡ score and PCT were independent risk factors of deterioration and death in CAP patients.ConclusionsThe better predictability of clinic outcome of CAP is APACHEⅡ score, PSI score, CURB-65 score, and PCT respectively in order, while the APACHEⅡ score and PCT concentration were independent risk factors for exacerbation and mortality in CAP patients. The predictive ability of a single PCT measurement is limited. The combination of APACHEⅡ score and PCT may increase specificity, but reduce sensitivity.