Clinical Research On The Combined Blood Purification Model With Insulin Resistance Of MODS Patients

Objectives:To research the clinical curative effect on the combined blood purification model with insulin resistance of MODS patients, to explore the best blood purification with insulin resistance of MODS patients and clarify the possible mechanism of insulin resistance of MODS patients.Methods:60 MODS patients were selected, randomly divided into single blood purification model (Continuous venous-venous hemofiltration) and combined blood purification model (Continuous veno venous hemofiltration+hemoperfusion),30 cases every group. To observe the basic situation of patients in the two groups:Age, Gender, APACHE Ⅱ score within 24 hours in hospital, SOFA score within 24 hours in hospital. To collect the changes of clinical indicators before the treatment, after the treatment of 7 d:FBG (Fasting blood glucose),HbAlc(Glycosylated hemoglobin), FINS (Fasting insulin), CRP(C-reactive protein),HOMA-IR (Insulin resistance index), BGSD (The standard deviation of BG), BGcv (BG Coefficient of variation),IL-1(Interleukin-1), IL-6 (Interleukin-6), IL-8 (Interleukin-8), TNF-α (Interferon),according to HOMA-IR (Insulin resistance index)>2.69 after treatment, divided into insulin resistance group and insulin nonresistance group, and to compare whether there were different or not in IL-1 (Interleukin-1), IL-6 (Interleukin-6), IL-8 (Interleukin-8), IFN-a (Interferon). Epidata 3.02 was used to entry data, double entry method was used to entry experimental data, after verification for the two correct data, SPSS 20.0 was used to do statistical analysis combined with related major.Results:1、Two independent samples t test:There were no different with age of experimental group and control group, APACHE Ⅱ score, SOFA score (P>0.05), four table x2 test:Gender of experimental group and control group had no statistical difference (P=0.301), there were no different with FBG (Fasting blood glucose), FINS (Fasting insulin), HOMA-IR (Insulin resistance index), BGSD (The standard deviation of BG), BGcv (BG Coefficient of variation) of experimental group and control group before treatment (P>0.05), IL-1 (Interleukin-1), IL-6 (Interleukin-6), IL-8 (Interleukin-8), IFN-a (Interferon) of experimental group and control group before treatment had no statistical difference (P>0.05).2、Two independent samples t test:FBG (Fasting blood glucose),HbAlc (Glycosylated hemoglobin), FINS (Fasting insulin), CRP(C-reactive protein),HOMA-IR (Insulin resistance index), BGSD (Standard deviation of BG),BGCV (BG Coefficient of variation), IL-1 (Interleukin-1), IL-6 (Interleukin-6), IL-8(Interleukin-8), TNF-a (Interferon) of experimental group and control group after treatment all had statistical difference (P<0.05).3、Paired t test: FINS(Fasting insulin), CRP(C-reactive protein), FBG (Fasting blood glucose),BGSD(The standard deviation of BG),BGCV (BG Coefficient of variation), IMS (Ordinary insulin dosage), IL-1 (Interleukin-1), IL-6 (Interleukin-6), IL-8(Interleukin-8), TNF-a (Interferon) of experimental group and control group before and after treatment all had statistical difference (P<0.05), but HbAlc (Glycosylated hemoglobin) had no difference (P>0.05).4、Two independent samples t test:IL-1 (Interleukin-1),IL-6(Interleukin-6),IL-8 (Interleukin-8), TNF-a (Interferon) of insulin resistance group and insulin nonresistance group all had statistical difference (P<0.05).5、Simple linear correlation analysis:HOMA-IR (Insulin resistance index) and IL-1 (Interleukin-1) had correlation (P<0.001, r=0.637), HOMA-IR (Insulin resistance index) and IL-6 (Interleukin-6) had correlation (P<0.001, r=0.664), HOMA-IR (Insulin resistance index) and IL-8 (Interleukin-8) had correlation (P<0.001, r=0.574), HOMA-IR (Insulin resistance index) and TNF-a (Interferon) had correlation (P<0.001, r=0.844)Conclusions:1、The clinical curative effect of the combined blood purification model with insulin resistance of MODS patients had advantage on single blood purification model (CVVH).2% Clearance rate of blood inflammatory mediators of the combined blood purification model with MODS patients was higher than single blood purification model (CVVH), blood inflammatory mediators of insulin resistance group were higher than insulin nonresistance group.3. Insulin resistance index had correlation with blood inflammatory mediators (IL-1, IL-6, IL-8, IFN-α).