The Research Of The Intensive Insulin Therapy On The Critical Illness With Hyperglycemia Of Differentiation Of Symptoms And Signs For Classification

Objective To observe the value of intensive insulin therapy on differentiation of symptoms and signs for classification of syndrome in the critical illness with hyperglycemia and try to explain it's relation of thyroid axis,β-EP,IL-6 and differentiation of symptoms and signs for classification of syndrome.Methods 50 eligible patients who achieve scores of APACHE II,admitted to our medical or surgical intensive care unit were allocated randomly to receive tight control of blood glucose by intensive insulin therapy (maintenance of blood glucose at a level between 4.4mmol/L and 6.1mmol/L,30patients) or to receive conventional treatment (maintenance of blood glucose at a level between 10.0 mmol/L and 11.1mmol/L,20patients). We also collected 3ml venous blood to detect FT3,FT4,TSH,β-EPand IL-6 expression of serum by the way of ELISA pretherap,on the1d,3d,7d after patients being admitted intensive care units(ICU). The relation of differentiation of symptoms and signs for classification of syndrome,mortality,APACHE IIand IL-6 of the two groups patients were observed..Results:①Mortality(6.7% vs 35%,P<0.05)of 30 patients who received intensive insulin therapy was obviously lower than that of 20 patients who received conventional treatment.②Levels of FT3 of serum (2.38±0.65 vs 2.03±0.45,P<0.05;2.98±0.85 vs 2.23±0.70,P<0.05;4.18±1.30 vs 3.15±1.15,P<0.05)on 1d,3d,7d ,of 30 patients who received intensive insulin therapy, were evidently higher to that of 20 patients who received conventional treatment.;Levels of FT4and TSH of serum have no marked change.the number of abnormality among FT3 was positively correlated to APACHEⅡscore,while a significantly correlation was seen between the number and the mortality.③β-EP activity of serum(6.58±1.31 vs 7.79±2.20,P<0.05;3.63±0.88 vs 5.22±1.36,P<0.01)on 1d, 3d, of 30 patients who received intensive insulin therapy, was obviously below to that of 20 patients who received conventional treatment.④IL-6 expression of serum on 1d, 3d,7d,,of 30 patients who received intensive insulin therapy,was obviously below to that of 20 patients who received conventional treatment(274.69±51.66 vs 309.45±41.87,P<0.05;199.39±45.60 vs 244.13±74.87,P<0.05;109.07±23.68 vs 125.04±16.70,P<0.05).⑤The distribution of the four kinds of model is quite well distributed, APACHEⅡscore of the sthenic heat syndrome is the lowes(tP<0.05),the prognosis is the best; stagnancy of Blood and Qi syndrome is the highest(P<0.05), the prognosis is the worst. They both have difference . They all have prominent difference except TSH between before and after treating (P﹤0.01). They both have difference in each type of syndrome of IL-6 . the sthenic heat syndrome and stagnancy of Blood and Qi syndrome both have difference compared with other kinds of model of each factor(P<0.05). Conclusion (1) Tight control of blood glucose by intensive insulin therapy is able to notable improve dysthyroid of critical illness with hyperglycemia,to lower the level ofβ-EP and IL-6 of serum,to relieve systemic inflammatory response syndrome and improve immune state, accordingly to lower the mortality and improve prognosis of patient.(2)In the evere case with hyperglycemia, The distribution of the four kinds of model is quite well distributed, They both have significantly difference to the improve of APACHEⅡscore in the group of differentiation of symptoms and signs for classification of syndrome between patients who received intensive insulin therapy and conventional treatment. APACHEⅡscore of the sthenic heat syndrome is the lowest,the prognosis is the best; stagnancy of Blood and Qi syndrome is the highest, the prognosis is the worst. Through APACHEⅡscore provid the theory according for the treat and prognosis of clinical traditional Chinese medicine differentiatiosymptoms and signs. They all have prominent difference except TSH between before and after treating . FT3,FT4 are the highest in the sthenic heat syndrome, are the lowest in the stagnancy of Blood and Qi syndrome;β-EP,IL-6 are the lowest in the sthenic heat syndrome, the highest in the stagnancy of Blood and Qi syndrome. Each factor in the critical illness with hyperglycemia before and after treating, patient's condition is the best in the sthenic heat syndrome,patient's condition is the worst in the stagnancy of Blood and Qi syndrome.