[Effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma].
OBJECTIVE
To investigate the effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma.


METHODS
Eighty severely injured patients were divided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2-4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6-8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-alpha, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed.


RESULTS
High fever appeared in 9 patients in IT group, and WBC exceeded 10.0 x 10(9) for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 patients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5%). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-alpha and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3-7 ( P < 0.05 or P < 0.01), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group (P < 0.05 or P < 0.01). Plasma levels of TNF-alpha (1.3 +/- 0.6 microg/L) and CRP (55 +/- 16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0 +/- 0.8 microg/L, 89 +/- 20 mg/L, respectively, P < 0.01).


CONCLUSIONS
Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.
Department of Emergency, the Third People's Hospital, Chongqing 400014, China.
Bai-Gang
BG
Yan
Shi-Wei
SW
Xu
Wei
W
Liu
Hua
H
Li
Wen-Feng
WF
Zhao
Jian
J
Liu
Zhong-Geng
ZG
Wan
Jun
J
Zeng
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007249:Inflammation; D007328:Insulin / Q000008:administration & dosage*; D007376:Interleukin-2 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
D007328:Insulin; D007376:Interleukin-2