Effect Of Controlling Of Blood Glucose On Serum Cytokines In Patients With Multiple Trauma Concomitant With Head Injury

Objective To study the effect of controlling of blood glucose on inflammatory and anti-inflammatory cytokines in patients with multiple trauma concomitant with severe head injury and the effect of Acute Physiology and Chronic Health Evaluation II (APACHEII) score and Glasgow Coma Score (GCS).Methods Thirty patients with stress hyperglycemia were randomly divided into intensive insulin therapy group and conventional insulin treatment group. Enzyme-linked immunoadsorbent assay (ELISA) method was used to determine serum tumor necrosis factor alpha (TNF-α), interleukin- 6(IL- 6) and interleukin- 10(IL-10) concentrations at 0, 24, 48, 72 h after entering surgical intensive care unit (SICU). C-reaction protein(CRP) was measured in a succedent week. And APACHEII score and GCS were also calculated on d 1, 3 and 7.Results Serum TNF-α, IL-6, IL-10 and CRP concentrations increased at 0 h in both groups. Serum TNF-αand IL-6 concentrations reduced at 24, 48, 72 h and serum IL-10 concentration increased at 24, 48, 72 h. Intensive insulin therapy significantly reduced serum TNF-αand IL-6 concentrations (P<0.05 or P<0.01) and increased serum IL-10 concentration (P<0.05). The ratio of IL-6 and IL-10 diminished at 24, 48, 72 h and in intensive insulin therapy group it had significant difference at 48, 72 h. Furthermore, serum CRP concentration also reduced in a succedent week and the concentration attenuated significantly on d 3, 4, 5, 6 in intensive insulin therapy group(P<0.05 or P<0.01). Moreover, intensive insulin therapy attenuated APACHEII score and increased GCS on d 7 (P<0.05).Conclusion Controlling of blood glucose by intensive insulin therapy in patients with multiple trauma concomitant with severe head injury can significantly attenuate serum inflammatory cytokines and increase anti-inflammatory cytokines. Furthermore, intensive insulin therapy can apparently decrease APACHEII score and enhance GCS and improve the critically illness′s mortality.