Study Of Dynamic Relationship Between Stress-induced Hyperglycemia And Hormone, Cytokines In Critically Ill Patients

Objective To investigate the mechanism of stress-induced hyperglycemia ofcritical illness in the first 7 days and obesever the dynamic changes of bloodglucose in the second days.Methods 18 Patients who were admitted to HUAXI hospital ICU betwereOct 2006 and Feb 2007 excluding diabetes or other ill which directlyinflence blood glucose Were selected and given the normal regulationstreatment .The blood RT,ALT,AST,Cr,BUN,K,NA,E,NE,ACTH,CORT,C-P,GH, IGF-Ⅰ, CPR were measured inthe morning at 9 of the first ,the third,the fifth and the seventh days.Theconcentrations of GL were determined by Radioimmunoassay,besides,theIFN-γand IL-4 were measured using ELASA in the laboratory.All patientswere evaluated with IFN-γ/IL-4 and APACHEⅡat the same time.The bloodglucose were controlled in 3.9-10mmol/L,record it erery 4 hours for 14days.Analyse the relationship between blood glucose and hormone,cytokines in the first ,the third,the fifth and the seventh days.The bloodglucose and insulin dosage were compared with T-test.Results E, NE, CORT, CRP attained the high peak the first day in stress. The ACTH started going up obviously from the first days, getting the highpeak the third days, descending henceforth. The GL went up latest, tallestthe fifth days.E, NE, CORT, ACTH, GL all recovered to the normal levelon the seventh dayses. GH and IGF-Ⅰfluctuated at normal Scope slightly.CRP and C-P went up obviously at all point, special CRP average valueexceeded the normal value is near 3000％. IFN-γand ratio of Th1/Th2cytokines (IFN-γ/ IL-4) were decreased but IL-4 was elevated day byday.The hyperglycemia was related to much hormone,cell factor andAPACHEⅡfrom the first days to the third days,then,the relationship becamelittle and little, at the seventh days ,it only connected with IGF-1.The bloodglucose and the insulin dosage was still placed in the high level at thesecond seven days, they did not descend compared to the first 7 days.Conclusion These results show that stress-induced hyperglycemia ofcritical illness is usually occurred.The main reason of stress-inducedhyperglycemia at thefirst seven days in critical illness is NE, GL, ACTH, C-P, CORT, GH andother cell factor, especially the first three days. There is no strong significantcorrelation between them after five days. The stress acute hormone and theinflammation factors of the overwhelming majority have already recover togo to normally after seven days, but the blood glucose maintains the highlevel continuously.