Immunological and prognostic effects of short-term intensive glucose control on severe infection complicated with stress hyperglycemia

LI Wenwu; OUYANG Yanhong

doi:10.13431/j.cnki.immunol.j.20170157

Abstract：To investigate the effect of short-term intensive glucose control on immunity function and prognosis in severe infection combined stress hyperglycemia patients,76 patients with severe infection combined stress hyperglycemia were randomly divided into control group (whose blood glucose was controlled between 7.8-10.0 mmol/L) and intensive group (whose blood glucose was controlled between 4.4-6.1 mmol/L).The serum inflammatory factor indexes (CRP,IL-6,TNF alpha) and T lymphocyte subsets (CD4+,CD8+ and CD4+/CD8 +) of two groups were detected on day 1 and day 7 post-admission.The fasting plasma glucose (FPG) levels on the day 1,day 3 and day 7 post-admission,blood glucose variability,therapeutic time,case fatality rate and hypoglycemia incidence were compared between the two groups of patients.The levels of serum CRP,IL-6,TNF alpha on the day 7 post-admission in the intensive group were significantly lower than those in the control group,and also lower than those levels on the day 1 (P＜0.05).The levels of CD4+,CD47CD8+ on the day 7 were higher in patients of intensive group than those in the control group,and also lower than those levels on the day 1 (P＜0.05).When patients admitted to hospital for 3 and 7 days,FPG level of patients in intensive group was significantly lower than that of the control group (P＜0.05).Hypoglycemia incidence,blood glucose variability,therapeutic time and case fatality rate of patients in intensive group were lower than those in the control group (P＜0.05).Logistic regression analysis showed that the APACHE IⅡ score (OR=2.214) and the blood sugar variability (OR=1.375) were independent risk factors for the death of the patient.In conclusion,short-term intensive glucose control to patients with severe infection combined stress hyperglycemia can enhance immune function,and improve the prognosis.