The Influence Of Intensive Insulin Therapy On Inflammatory Response And Immune States In Severe Trauma Patients

Background:"Stress"hyperglycemia may be associated with increase mortality and poor recovery in critical illness. Tighter control of serum glucose with intensive insulin therapy showed to improve the prognosis for those patients. Adverse outcomes of the severe injuries are often caused by systemic inflammation and unbalanced immune function, which contribute to increasing infection and MODS. Pro-inflammatory cytokine, TNF-αand IL-6, as well as acute phase proteins, provoke inflammatory cascade after trauma. Intensive insulin therapy exerts a powerful anti-inflammatory effect during critical illness which at least partially explains improvement in morbidity and mortality. But monocytes, the bridge between natural and acquired immune reaction, in posttrauma patients received insulin regimen have not been previously studied for the changing of morphology, CD14 and HLA-DR coexpression, so the exact effects of insulin therapy on immune states in severe trauma patients is still unclear. We evaluate the influence of intensive insulin therapy on inflammatory response and monocytes phagocytic/antigen-presenting capacities, to documents a potentially immune modulation activity of insulin treatment in severe trauma patients.Materials and Methods: Insulin therapy directed at establishing euglycemia was investigated in 32 sICU injured patients ISS >20, tailored to control blood glucose levels in the range 6-8mmol/L, whereas the conventional treatment group only received insulin when glucose levels exceeded 11.1 mmol/L. Blood samples were obtained at 0, 2, 4, 6 and 8 days after admission. ELISA method was used to determine the TNF-αand IL-6 levels while other immunological markers such as IgA, IgG, IgM, C3, C4 and acute inflammatory protein CRP in each group were examined to determine the different inflammatory and immune response following trauma. Two-color flow cytometric(FCM) analysis was used for the detection of the human leukocyte antigen HLA-DR expression on CD14+ monocytes. Phagocytosis by monocytes was determined with the use of PHAGOTEST kits.