Associate Research Of Intensive Insulin Therapy On The Critical Illness With Hyperglycemia And The Yin-Yang Syndrome Of Chinese Medicine

Objective:To observe the associate research of intensive insulin therapy on the critical illness with hyperglycemia and the Yin-Yang syndrome of Chinese medicine. Methods:The paitents of hyperglycemia and critical were randomly allocated to either the intensive insulin therapy approach with insulin infused to maintain blood glucose at the level of 4.4～6.1mmol/L, or the conventional group,with insulin infused to maintain blood glucose at the level of 10～11.1mmol/L by the insulin pump or vein spoting or inject insulin combinating multiple blood sugar monitoring a day. Death ratio and blood glucose of the two groups patients were observed. According to Chinese differentiation of symptoms and signs for classification of syndrome, we separated the patients to Yin and Yang syndrome, to observe the change between before and after the therepy.Blood was drown from elbow vein in each patient respectively at the frist,third,fifth,tenth day after their admission. the levels of GH,IGF-1,MIF,sCD4,sCD8 were detected by ELISA. Results:①Blood glucose , Mortality of 30 patients who received intensive insulin therapy was obviously lower than that of 20 patients who received conventional treatment.②Compared with the conventional group,the intensive approach had a marked high IGF-1 levels on 3d,5d, 10d.The serum levels of GH in intensive group were significantly lower than those of the conventional group on 5d, 10d. The IGF-1/GH ratios in intensive group were significantly lower than those of the conventional group on 5d, 10d.③MIF levels on 3d, 5d, 10d, of 30 patients who received intensive insulin therapy, was obviously below to that of 20 patients who received conventional treatment.④Compared with the conventional group,the intensive approach had a marked high sCD4 levels on 3d,5d,10d.The serum levels of sCD8 in intensive group were significantly lower than those of the conventional group on 5d,10d.⑤There were 7 patients of the Yin syndrome group in intensive insulin therapy intervered the Yang syndrome, while there were 9 pateints of the Yang syndrome group in the conventional group interapy intervered the Yin syndrome.⑥There were marked difference in the levels of IGF-1.GH.IGF-1/GH between the Yin and the Yang syndrome.The level of GH in the Yang syndromes on the seventh day were lower than the conventional group interapy in the intensive insulin therapy group,Beside the Yin syndromes , The level of IGF-1 were higher than the conventional group interapy in the intensive insulin therapy group, The level of IGF-1/GH were higher than the conventional group interapy in the intensive insulin therapy group on the Yang syndromes and the Yin syndromes on the third day.⑦The levels of MIF in the Yin syndromes were higher than the Yang syndrome. The level of MIF were lower than the conventional group interapy in the intensive insulin therapy group on the Yang syndromes and the Yin syndromes on the 1d,3d,7d.⑧The levels of sCD4 in the Yang syndromes were higher than the Yin syndrome. The level of sCD8 were lower than the conventional group interapy in the intensive insulin therapy group, The level of sCD4 were higher than the conventional group interapy in the intensive insulin therapy group ,The level of sCD4/sCD8 were higher than the conventional group interapy in the intensive insulin therapy group in the Yin syndromes on the third day.The level of sCD4/sCD8 were higher than the conventional group interapy in the intensive insulin therapy group,The level of sCD4/sCD8 were higher than the conventional group interapy in the intensive insulin therapy group in the Yin syndromes on the third day.Conclusion:Intensive insulin therapy is able to reverse the disturbance of GH/IGF-1 axis, thus improve the contiuning hypermetabolism and high breakdown condition advanced constructive metabolism.obviously improve the immune inhibited state and reduce inflammatory reaction in hyperglycemia critically paitents, make the Yin and Yang syndrome balance.