[Effects of intensive insulin therapy on serum immunoglobulin, complement levels and phagocytosis of monocytes in patients with severe trauma].
OBJECTIVE
To investigate the influence of intensive insulin therapy on serum immunoglobulin (Ig), complement levels and phagocytosis of monocytes in patients with severe trauma.


METHODS
Severe injured patients with injury severity score (ISS)>20 in surgical intensive care unit (ICU) were randomly divided into two groups, intensive insulin therapy and conventional therapy. Blood glucose levels in intensive insulin therapy and conventional therapy groups were maintained at 4-6 mmol/L and <11.1 mmol/L, respectively. Blood samples were obtained on 0, 2, 4, 6 and 8 days after admission. Dynamic changes of immunological parameters including serum IgA, IgG, IgM, complements (C3, C4) levels were determined in each group at various intervals following trauma. Phagocytosis of monocytes was also measured by use of phagotest kits after blood cells were incubated with fluorescein isothiocyanate (FITC)-labeled E. coli in a heated water bath at 37 centigrade.


RESULTS
Serum IgA, IgG, IgM, C3 and C4 levels were low in two groups at admission, and elevated after treatment with recovery to normal range on 6-8 days. Serum C3 and C4 levels in intensive insulin therapy group were much lower than those in conventional therapy group (both P<0.05) with delayed recovery to normal range. There were no significant differences in serum IgA, IgG and IgM levels between two groups (all P>0.05). For the patients with intensive insulin therapy, phagocytosis of monocytes was markedly enhanced on 4 and 6 days compared with those at admission (both P<0.05), and E. coli-FITC positive rates were significantly higher than those with conventional therapy on 2, 4 and 6 days after admission (all P<0.05).


CONCLUSIONS
Intensive insulin therapy can markedly improve immune function and enhance phagocytosis of monocytes, which might be used as one of effective methods to increase the host defense ability in traumatic patients.
Zhao
Xiao-dong
XD
Emergency and Burns Institute, the First Affiliated Hospital of General Hospital of PLA (formerly 304th Hospital), Beijing 100037, China.
Yao
Yong-ming
YM
Ma
Jun-xun
JX
Liang
Hua-ping
HP
Yan
Rui-min
RM
Zhang
Lian-yang
LY
Li
Zhan-liang
ZL
He
Zhong-jie
ZJ
Deng
Qun
Q
Du
Jun-dong
JD
Yan
Bo-gang
BG
D003165:Complement System Proteins / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007136:Immunoglobulins / Q000097:blood*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D016555:Matched-Pair Analysis; D009000:Monocytes / Q000187:drug effects / Q000276:immunology*; D010587:Phagocytosis / Q000187:drug effects*; D014947:Wounds and Injuries / Q000097:blood / Q000188:drug therapy* / Q000276:immunology
D007004:Hypoglycemic Agents; D007136:Immunoglobulins; D007328:Insulin; D003165:Complement System Proteins