title: [Study of relationship between stress hyperglycemia and insulin-resistance related factors].
abstract: OBJECTIVE
  To observe related factors in the stress hyperglycemia (SHG) of critical illness and to investigate possible pathogenesis of insulin-resistance (IR).
  
  
  METHODS
  Blood glucose (BG), insulin (INS), C-peptide (C-P), cortisol (Cor), somatostatin (SS), glucagon (Gluc), tumor necrosis factor-alpha (TNF-alpha),soluble tumor necrosis factor receptor I (sTNFRI) and sTNFRII were determined respectively by radioimmunoassay (RIA) or enzyme linked immunoadsorbent assay (ELISA) in 47 SHG patients with critical illness and 15 healthy volunteers serving as normal controls. Their insulin sensitivity index (ISI) was calculated.
  
  
  RESULTS
  (1)Eleven of 47 patients died, while 36 cases survived. Mean acute pathology and chronic health evaluation II (APACHEII) was (13.89+/-6.29) scores within 24 hours after admission to intensive care unit (ICU), mean days of stay in ICU was (5.5+/-6.3) days,and mean duration of mechanical ventilation (MV) was (51.49+/-66.01) hours. (2)The concentrations of INS, ISI, C-P, Cor, Gluc, TNF-alpha, sTNFRI and sTNFRII in 47 SHG patients with critical illness were significantly higher than those in normal controls, except for SS, the differences among groups were significant (P<0.05 or P<0.01). (3)The results of analysis of severity of SHG showed that the more severe SHG was, the higher C-P and INS were, and the less prominent ISI was. (4)Analysis of scores of APACHEII in 47 cases of SHG showed that BG was not increased, but duration of MV, Cor, Gluc, SS, TNF-alpha, sTNFRI and sTNFRII were significantly increased with higher scores of APACHEII. (5)The effect of SHG was significant on MV (F=10.438,P<0.01), but not significant for outcome and days of stay in ICU. (6)The main correlative factors of BG were respectively concentrations of INS (r=0.674, P<0.01), C-P(r=0.552,P<0.01), ISI (r=-0.787, P<0.01), APACHE II(r=0.267,P<0.05) and sTNFRI(r=0.465, P<0.01).
  
  
  CONCLUSIONS
  These results show that main reason of SHG in critical illness is IR. There is no strong significant correlation between acute stress hormones and the level of SHG. sTNFRI has an influence on SHG. However, the over release of TNF-alpha and sTNFRII could be the results of seriousness of the critical illness. There is closely correlation between BG and MV, but not with the age, outcome and days of stay in ICU. The strategy of control and therapy of SHG should be alleviation of stress and improve the utilization of BG in the tissue, and increase sensitivity of INS in the tissue.
authors.affiliation: Critical Care Unit, Ningxia Medical College Affiliated Hospital, Yinchuan 750004, Ningxia, China.
authors.forename: Xiang-yuan
authors.initials: XY
authors.lastname: Cao
authors.forename: Xiao-hong
authors.initials: XH
authors.lastname: Wang
authors.forename: Shao-lin
authors.initials: SL
authors.lastname: Ma
authors.forename: Xiao-jun
authors.initials: XJ
authors.lastname: Yang
authors.forename: Xiao-qi
authors.initials: XQ
authors.lastname: Wang
authors.forename: Huan
authors.initials: H
authors.lastname: Ding
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Lan-jie
authors.initials: LJ
authors.lastname: He
authors.forename: Xiao-wei
authors.initials: XW
authors.lastname: Ma
authors.forename: Xi-gang
authors.initials: XG
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D002096:C-Peptide / Q000097:blood; D016638:Critical Illness; D005260:Female; D005934:Glucagon / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006943:Hyperglycemia / Q000209:etiology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D002096:C-Peptide; D007328:Insulin; D014409:Tumor Necrosis Factor-alpha; D005934:Glucagon; D006854:Hydrocortisone