Effects of short-term intensive treatment on blood glucose control in patients with severe infection complicated by stress hyperglycemia

SUN Yueling

doi:10.3969/j.issn.1002-7386.2018.01.002

Abstract：Objective To investigate the ffects of short-term intensive treatment on blood glucose control in patients with severe infection complicated by stress hyperglycemia.Methods Eighty-four patients with severe infection complicated by stress hyperglycemia who were admitted and treated in our hospital from November 2014 to October 2015 were randomly divided into intensive treatment group and control group,with 42 patients in each group.The patients in intensive treatment were treated by short-term intensive insulin treatments,and patient's blood glucose was controlled between 4.0 ～ 6.1 mmol/L,however,the patients in control group were treated by conventional insulin therapy,with blood glucose being controlled between 8.0 ～ 10.0mmol/L.The levels of T lymphocyte subsets including CD4+,CD8+ and CD4+/CD8+,and serum inflammatory indexes including CRP,IL-6,TNF alpha were detected for both groups,moreover,the levels of fasting plasma glucose (FPG),therapeutic time,case fatality rate and incidence rate of hypoglycemia event were observed and compared between two groups.Results The levels of CD4+,CD4+/CD8+ in intensive treatment group were significantly higher than those in control group (P ＜ 0.05),however,the levels of CD8+ in intensive treatment group were significantly lower than those in control group (P ＜ 0.05).The decrease degree of CRP,IL-6,TNF-α levels in intensive treatment group was more obvious than that in control group (P ＜0.05).On 3,7 day after admission to hospital the FPG levels in intensive treatment group were significantly lower than those in control group (P ＜ 0.05),however,the incidence rate of hypoglycemia in intensive treatment group was significantly higher than that in control group (P ＜ 0.05),moreover,the therapeutic time and 28-day case fatality rate in intensive treatment group were significantly lower than those in control group (P ＜ 0.05).On admission to hospital,there were significant differences in the APACHE Ⅱ score,therapeutic time between death case group and survival case group (P ＜ 0.05),however,there were no significant differences in the FPG levels and incidence rate of hypoglycemia between death case group and survival case group (P ＞ 0.05).Logistic regression analysis showed that APACHE Ⅱ score (OR =2.214) and blood glucose variability (OR =1.375) were independent risk factors of influencing mortalityof patients.Conclusion The short-term intensive blood glucose control in treatment of severe infection complicated by stress hyperglycemia can decrease FPG levels obviously,and can enhance patient's immune function,improve the inflammatory response,thus,which is good for prognosis of patients.