胰岛素和葡萄糖联合应用对严重烫伤MODS大鼠炎性因子水平的影响
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摘要
目的研究胰岛素通过和不通过控制高血糖对严重烫伤多器官功能不全(MODS)大鼠炎性因子水平的影响,探讨胰岛素体内抗炎作用机制,为创伤外科使用胰岛素抗炎提供依据。方法 60只严重烫伤MODS大鼠,随机分为严重烫伤MODS大鼠胰岛素治疗高血糖控制组(INS组,20例)、胰岛素和葡萄糖联合治疗高血糖非控制组(INS+GLU组,20例)以及严重烫伤MODS大鼠治疗对照组(C组,20例),测定不同组大鼠伤前和伤后1、3、5、7d空腹血糖、血浆可溶性髓样细胞触发蛋白受体1(sTREM-1)、肿瘤坏死因子(TNF)-α、高迁移率族蛋白B1(HMGB1)水平,并进行统计分析。结果 INS组伤后各时点空腹血糖水平明显低于C组,差异有统计学意义(P<0.01),而INS+GLU组伤后各时点与C组相比,差异无统计学意义(P>0.05);INS组和INS+GLU组伤后各时点血浆sTREM-1、TNF-α和HMGB1水平均明显低于C组,差异有统计学意义(P<0.01);INS组伤后各时点血浆sTREM-1、TNF-α和HMGB1水平与INS+GLU组相比,差异无统计学意义(P>0.05)。结论胰岛素可降低严重烫伤MODS大鼠炎性反应,胰岛素体内抗炎作用并不通过控制高血糖发挥作用。
Objective To investigate the influence of insulin on inflammatory factors levels of multiple organ dysfunction syndrome(MODS)mice after severe scald by means of controlling hyperglycemia or not,and to explore the insulin′s mechanism of in vivo anti-inflammation so as to provide a basis for using insulin anti-inflammation in traumatic surgery.Methods Sixty MODS mice after severe scald were randomized into the insulin treatment hyperglycemia control group(INS group,n=20),insulin combined glucose treatment hyperglycemia non-controlled group(INS+GLU group,n=20)and treatment control group(group C,n=20).Fasting glucose level,plasma sTREM-1,TNF-α,and HMGB1 levels were detected before scald injury and on 1,3,5,7dafter scald injury.Statistical analysis was performed.Results Fasting glucose levels at various time points after injury in the INS group were significantly lower than those in the group C with statistical difference(P<0.01),while which at various time points had no statistical difference between the INS+GLU group and group C(P>0.05);the levels of plasma sTREM-1,TNF-α,and HMGB1 at various time points after injury in the INS group and INS+GLU group were significantly lower than those in the group C,the difference was statistically significant(P<0.01),which at various time points had no statistical difference between the INS group and INS+GLU group(P>0.05).Conclusion Insulin can decrease the inflammation reaction of MODS mice after severe scald,insulin does not play the in vivo anti-inflammatory action by controlling hyperglycemia.
Objective To investigate the influence of insulin on inflammatory factors levels of multiple organ dysfunction syndrome(MODS)mice after severe scald by means of controlling hyperglycemia or not,and to explore the insulin′s mechanism of in vivo anti-inflammation so as to provide a basis for using insulin anti-inflammation in traumatic surgery.Methods Sixty MODS mice after severe scald were randomized into the insulin treatment hyperglycemia control group(INS group,n=20),insulin combined glucose treatment hyperglycemia non-controlled group(INS+GLU group,n=20)and treatment control group(group C,n=20).Fasting glucose level,plasma sTREM-1,TNF-α,and HMGB1 levels were detected before scald injury and on 1,3,5,7dafter scald injury.Statistical analysis was performed.Results Fasting glucose levels at various time points after injury in the INS group were significantly lower than those in the group C with statistical difference(P<0.01),while which at various time points had no statistical difference between the INS+GLU group and group C(P>0.05);the levels of plasma sTREM-1,TNF-α,and HMGB1 at various time points after injury in the INS group and INS+GLU group were significantly lower than those in the group C,the difference was statistically significant(P<0.01),which at various time points had no statistical difference between the INS group and INS+GLU group(P>0.05).Conclusion Insulin can decrease the inflammation reaction of MODS mice after severe scald,insulin does not play the in vivo anti-inflammatory action by controlling hyperglycemia.
引文
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[13]关云艳,吴海荣,王倩.髓样细胞表达的触发受体-1研究进展[J].国际免疫学杂志,2010,33(1):49-52.
[14]毕艳,蔡梦茵,梁华,等.早期胰岛素治疗对糖尿病大鼠肝脏核因子-KB炎症通路的影响[J].中华内科杂志,2009,48(1):17-22.
[15]王占科,雷万生,柴长春,等.极化液对严重烫伤内毒素血症大鼠胰岛β细胞功能的影响[J].中华创伤杂志,2006,22(9):709-711.
[16]Wang Z,Liu L,Hu T,et al.Protective effect of glucoseinsulin-potassium(GIK)on intestinal tissues after severe burn in experimental rats[J].Burns,2012,38(6):846-854.
[2]姚咏明,祝筱梅.严重创伤感染及其并发症处理的若干对策[J].中华创伤杂志,2015,31(3):194-196.
[3]Burke SJ,Stadler K,Lu D,et al.IL-1βreciprocally regulates chemokine and insulin secretion in pancreaticβ-cells via NF-κB[J].Am J Physiol Endocrinol Metab,2015,309(8):E715-726.
[4]程思.创伤后应激性高血糖的诊治进展[J].重庆医学,2012,41(33):3543-3545.
[5]Jeschke MG,Pinto R,Herndon DN,et al.Hypoglycemia is associated with increased postburn morbidity and mortality in pediatric patients[J].Crit Care Med,2014,42(5):1221-1231.
[6]梁丽枝,陈向军,赵晓春,等.胰岛素强化治疗对严重烧伤延迟复苏高血糖患儿炎性细胞因子水平及预后的影响[J].中华烧伤杂志,2013,29(1):26-28.
[7]王占科,何凤田,许霖水,等.葡萄糖钾盐体外协同增强胰岛素抗炎作用[J].免疫学杂志,2009,25(2):158-160.
[8]陈荣剑,王占科,张晓云,等.胰岛素和丙酮酸乙酯联合治疗拮抗严重烫伤后MODS大鼠炎症反应和氧化应激的实验研究[J].解放军医药杂志,2015,26(8):45-50.
[9]陈晓梅.胰岛素强化治疗对脓毒症患者血清非特异性炎性因子表达水平及预后的影响[J].检验医学与临床,2014,11(4):471-472.
[10]Jeschke MG,Kraft R,Emdad F,et al.Glucose control in severely thermally injured pediatric patients:what glucose rangeshouldbethetarget[J].AnnSurg,2010,252(3):521-527.
[11]汪仕良,邓诗琳.烧伤代谢营养学[M].石家庄:河北科技出版社,2009:325-332.
[12]关云艳,王倩,吴海荣,等.54例危重病患者sTREM-1与炎症因子表达的相关性及对预后的影响[J].重庆医学,2014,42(19):2415-2416.
[13]关云艳,吴海荣,王倩.髓样细胞表达的触发受体-1研究进展[J].国际免疫学杂志,2010,33(1):49-52.
[14]毕艳,蔡梦茵,梁华,等.早期胰岛素治疗对糖尿病大鼠肝脏核因子-KB炎症通路的影响[J].中华内科杂志,2009,48(1):17-22.
[15]王占科,雷万生,柴长春,等.极化液对严重烫伤内毒素血症大鼠胰岛β细胞功能的影响[J].中华创伤杂志,2006,22(9):709-711.
[16]Wang Z,Liu L,Hu T,et al.Protective effect of glucoseinsulin-potassium(GIK)on intestinal tissues after severe burn in experimental rats[J].Burns,2012,38(6):846-854.