The Preliminary Discussion About The Relationship Between Blood Glucose Changes And MODS And About The Influence Of Huanglian Jiedu Decoction On Both

ObjectiveThe purpose of this study is to explore the blood sugar change Index steady-state model evaluation method of Insulin Resistance(HOMA IR Index,Homeostasis model Assessment of Insulin to hold),steady state model evaluation method of beta cells secrete Index(HOMA-beta Index),blood glucose Instability Index(GLI,Glycemic Instability Index)and Multiple organ Dysfunction Syndrome(MODS,Multiple rgan Dysfunction Syndrome),the relation of huanglian jiedu decoction on patients with MODS HOMA IR,HOMA-beta,GLI blood indexes such as the intervention of the role and preliminary discussion on its possible mechanism.MethodsIn May 2016 to March 2017 emergency center in the first affiliated hospital of guangzhou university of TCM in intensive medicine two 47 patients with MODS to be included in the standard,included in the study were confirmed in 24 hours;Randomly selected to 41 patients with the same period in accordance with SIRS diagnosis,set as control group.MODS research object according to the principle of random grouping,including 22 cases of huanglian jiedu decoction and set to Chinese traditional medicine group,another 25 cases not huanglian jiedu decoction and set it to the Chinese medicine group;For selected patients,in the diagnosis of MODS and treatment within 24 hours after 3 days,5 days for APACHE Ⅱ score,SOFA score;At the same time in 3 days,5 days before and after treatment of peripheral venous blood collected at 7 o’clock in the morning to the hospital clinical laboratory,the determination of fasting blood glucose,fasting insulin,PCT(serum original calcitoninthe),CRP(serum C reactive protein);In 1-5 days into the,determination of glucose meter with the microcomputer every 2 hours a random blood glucose values.To use the above data HOMA IR,HOMA-beta formula,analysis of insulin resistance and beta cell function in patients with MODS,compared with pure western medicine of Chinese and western medicine treatment in patients with MODS.Combined with the existing literature research and the clinical research preliminarily HOMA IR,HOMA indices such as beta,GLI relations with MODS,evaluation of huanglian jiedu decoction intervention effect of changes in blood glucose in patients with MODS.Using HOMA2 software for insulin resistance index and beta cells secrete index is calculated,and compared with HOMA1 method to calculate the results of the same object,to explore a better evaluation software;Using MedCalc software changes in blood sugar index prediction MODS ROC curve analysis,explore a better predict the changes of blood sugar of MODS.Results1.Compared to traditional Chinese medicine,Chinese medicine group and control group data into groups of three groups of patients before treatment(including gender,age,APACHE Ⅱ score,SOFA score),gender,age groups of patients have no statistical difference(P>0.05),the traditional Chinese medicine and Chinese medicine group between the APACHE Ⅱ score,SOFA score no statistical difference(P>0.05),the control group patients with MODS APACHE Ⅱ score,SOFA score was statistically difference;Was comparable between the three groups of patients;2.The incidence of MODS patients with stress hyperglycemia and reached 51.6%,significantly higher than the patients without MODS,traditional Chinese medicine group and the Chinese medicine group,the incidence of MODS patients with stress hyperglycemia,compared with the control group patients were statistically significant differences.That is common among patients with MODS hyperglycemia.3.Upon examination,HOMA IR index,HOMA-beta index,GLI and fasting glucose,fasting insulin have obvious correlation;Will HOMA IR index,HOMA-beta index,GLI and MODS overall condition,organ index,inflammation index,statistical analysis results suggest HOMA IR index,HOMA-beta index,GLI with MODS significantly the illness severity,logarithm of HOMA IR index,HOMA-beta index,GLI and MODS patients with lung,kidney,liver function index and PCT and CRP has a linear correlation.4.Through treatment for 5 days and measurement results are repetitive measure analysis of variance,and,according to the results of huanglian jiedu decoction group of patients with SOFA score,HOMA IR index,HOMA-beta index,GLI and PCT compared with non huanglian jiedu decoction group,are statistically significant differences in the effect between groups;But the two groups of comparison,reduce no statistically significant difference between CRP.5.Regression analysis showed that HOMA2 and HOMA1 two kinds of method to calculate the IR and beta cells secrete index have a high correlation,P<0.05,there are statistically significant differences.By ROC curve analysis showed that HOMA IR,HOMA-beta,GLI,forecasting results MODS AG AUC>0.7,among them with HOMA-beta best(>0.9),and FBG,FINS correspond to the AUC<0.7.Conclusions1.Patients with MODS are widespread IR,stress hyperglycemia is forecast for MODS.2.HOMA IR index,HOMA-beta index,GLI closely associated with fasting blood glucose,fasting insulin,and organ index of the patients with MODS and inflammatory factors closely related,explain HOMA index,HOMA-beta index,GLI-IR can be as an indicator to evaluate the degree of patients with MODS is seriously ill.3.To HOMA index,HOMA-beta index,GLI-IR as a comparative study on the evaluation indexes,such as huanglian jiedu decoction combined western medicine therapy compared with western medicine treatment,according to the results of huanglian jiedu decoction can significantly improve the overall condition of MODS patients,improve insulin resistance in patients with MODS,conducive to the stable blood sugar,protect islet secretion,can significantly reduce inflammation factor index of PCT.4.Through the regression analysis shows that HOMA1 and HOMA2 to assess MODS patients with insulin resistance and islet cell secretion of good method;While both less tip:HOMA1 has more advantage in evaluation of islet cells secrete a function,HOMA2 have more advantages in terms of assessment of insulin resistance.5.Through the ROC curve analysis,HOMA IR,HOMA-beta,GLI and AG in the prediction of MODS has a certain value,can be used as diagnostic/MODS early warning indicators,especially HOMA-beta higher sensitivity and specificity of MODS.The single FBG,FINS prediction of MODS may have no value.