Research On The Relationship Of Between Inadequate Tissue Perfusion Or Inflammatory Response And Components Of Excreting Insulin In The Stress Hyperglycemia Of Critically Ill.

Objective⑴. To study the relationship between different tissue perfusion and the insulin's constituents of isletβ-cell secretion in stress hyperglycemia(SHG), and to understood the effect of inadequate tissue perfusion on isletβ-cell secretion function and its secretion constituents during critical illness. We intend to observe related factors and possible pathogenesis in the SHG of critical illness.⑵.To observe the relationship between inflammatory response and the constituents of isletβ-cell secretion during SHG in critically ill patients. It is aim to study the impact of inflammatory response on insulin resistance and the secretion function of isletβ-cell .Method A prospective and controlled study was performed. The patients with SHG and elevated arterial blood lactate(Lac) level(Lac≥2.0 mmol/L)within 2 hours after admission in intensive care unit(ICU) of the affiliated hospital of Ning Xia Medical University during November 2009 to May 2010 were included, and excluded other disease that influenced blood glucose(BG)directly and indirectly, such as diabetesa and endocrine disease. 47 patients were randomly selected. Another 21 patients with normal Lac(Lac<2.0mmol/L) were selected for the patients control group and 15 healthy volenteers for normal control group.⑴.There were 47 Patients with elevated Lac and 21 patients with normal Lac. 47 patients with elevated Lac were divided into two groups. The medium Lac group included 25 patients with Lac level:2.0～4.0 mmol/L, and high Lac group included 22 patients with Lac>4.0mmol/L. The concentration of serum proinsulin(PI), true insulin(TI), C-peptide (C-P) and immunoreactive insulin(IRI) were respectively measured in patients and healthy controls. Serum PI and TI were detected by enzyme linked immunosorbent assay (ELISA), Serum C-P was detected by chemiluminescent immunoenzymatic assay, and serum IRI was detected by radioimmunity assay (RIA). The secretion index of islet beta-cell(HOMA-β)and insulin resistance index (HOMA-IR) was calculated. The relationship between the above indicators were analyzed.⑵.Analising systemic inflammatory response syndrome(SIRS).There were 42 cases SIRS in 48 surviving patients of all 68 cases. According to the period of inflammatory response, 42 patients were divided into two groups: stress and the convalescence period. The tumor necrosis factor (TNF-α), BG, PI, TI, C-P and IRI were measured respectively. TNF-αlevel in serum were detected by ELISA. The relation between the above indicators were analyzed.Results⑴.The results of different Lac level:①. The secreted Insulin builders [medium (range),M(QR)] : TI in high Lac group was significantly lower than that in normal Lac group[0.74(0.37～4.04) vs 3.68(1.92～11.86)mU/L , P<0.01]. PI and C-P in high Lac group were significantly higher than those in nomal Lac [PI(pmol/L):8.48(3.43～15.54) vs 3.85(2.05～6.98);C-P(μg/L):3.13(2.38～12.3) vs 2.65(1.26～3.16),P<0.01 or P<0.05]。②. HOMA-βwere significantly reduced with higher level of Lac (P<0.05). HOMA–IR : was not significant difference among group nomal Lac, medium Lac and high Lac group(P>0.05).③. Correlation analysis : Lac to PI and C-P was positive correlation(r =0.322 , P= 0.015 ; r=0.513 , P= 0.000), and to TI and HOMA-βwas negative correlation(r = -0.353 , P =0.007 ; r = -0.294 , P =0.002).⑵. the results of different inflammatory response period grouped :①. The secreted insulin builders: The concentrations of TI was no difference among stress period, the convalescence period and healthy control group [3.68(1.57～7.70),3.42(2.41～7.40),1.46(0.35～4.90)mU/L, P>0.05]. The concentration of PI , C-P and IRI in stress period were significantly higher than those of in the convalescence period and healthy control group(P<0.05 or P<0.01).②. HOMA-IR in stress period was significantly higher than that in the convalescence period and healthy control group(P<0.05 or P<0.001). HOMA-βwas significant lower than that in the convalescenc period and healthy control group (P<0.05 or P<0.01).③. Correlation analysis : There were positive correlations between the concentration of TNF-αand PI , C-P , IRI and HOMA-IR(r =0.292 , P =0.013; r =0.397, P =0.000; r =0.344, P =0.003; r =0.324, P =0.005). There was negative correlations between concentration of TNF-αand HOMA-β(r = - 0.235, P =0.049). But there was no correlations between concentration of TNF-αand BG and TI(P>0.05).Conclusion⑴.There was significant relativity the degree of inadequate tissue perfusion with the constituents of isletβ-cell secretion. Its feature is the worse tissue perfusion was in SHG of critical illness, the higher PI and C-P were, the lower TI was.⑵. Inflammatory response impact isletβ-cell secretion and the conversion of secretion constituents. The more severe inflammatory response, the higher PI and C-P were, while TI secretes relative deficiency.In conclusion, These results show that main reason of SHG in critical illness is IR and isletβ-cell paracrisis and deceleration. Inadequate tissue perfusion state could lead to isletβ-cell paracrisis and deceleration. Inadequate tissue perfusion shoule be put right as soon as possible, which could be have actively effort to prevent and improve function of isletβ-cell, and have important significance to improve glycometabolism in SHG of critical illness. Inflammatory response could affect insulin resistance and the secretion function of isletβ-cell during stress hyperglycemia in critically ill patients. Early anti-inflammatory might reduce IR and protect isletβ-cell function to improve glycometabolism in SHG of critical illness.