组合式血液净化模式对MODS患者胰岛素抵抗的临床研究

发布时间：2018-03-04 22:21

  本文选题：连续静脉-静脉滤过　切入点：血液灌流　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的研究组合血液净化模式对MODS患者胰岛素抵抗的临床疗效,探讨改善MODS患者胰岛素抵抗最佳血液净化模式及阐明MODS患者出现胰岛素抵抗的可能机制。方法选取MODS患者60例,随机分为单一血液净化模式(连续静脉-静脉血液滤过)和组合式血液净化模式组(连续静脉-静脉血液滤过+血液灌流),每组各30例,观察两组患者基本情况：年龄,性别,入院24小时内APACHE Ⅱ评分,入院24小时内SOFA评分,收集治疗开始前、治疗后7 d临床指标变化情况:FBG(空腹血糖),HbA1c(糖化血红蛋白),FINS(空腹胰岛素),CRP (C-反应蛋白),HOMA-IR(胰岛素抵抗指数),BGSD (BG标准差),BGcv (BG变异系数),IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干扰素-α),根据治疗后HOMA-IR(胰岛素抵抗指数)2.69把患者分成治疗后胰岛素抵抗组和治疗后胰岛素不抵抗组并比较两组患者IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(干扰素-α)是否有差异,采用Epidata 3.02软件包数据录入,采用双录入方法对试验数据进行录入,两次数据核查无误后,采用spss20.0统计学软件包结合相关专业进行统计学分析。结果1、经两独立样本t检验：试验组和对照组年龄、APACHE Ⅱ评分、SOFA评分均无统计学差异(P0.05),经四表格χ2检验：试验组和对照组性别无统计学差异(P=0.301)：试验组和对照组治疗前FBG(空腹血糖)、FINS(空腹胰岛素)、HOMA-IR(胰岛素抵抗指数)、BGSD(空腹血糖标准差)、BGCV(口服血糖变异系数均无统计学差异(P0.05)；试验组合对照组治疗前IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干扰素-α)均无统计学差异(P0.05)。2、经两独立样本t检验：试验组组和对照组治疗后FINS(空腹胰岛素)、CRP (C-反应蛋白)、HOMA-IR(胰岛素抵抗指数)、FBG(空腹血糖)、BGsD(血糖标准误)、BGCV(血糖变异系数)、INS(普通胰岛素用量)、IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干扰素-α)均有统计学差异(P0.05)。3、经配对t检验：试验组治疗前后FINS(空腹胰岛素)、HOMA-IR(血糖抵抗指数)、CRP(C-反应蛋白)、FBG(空腹血糖)、BGsD(血糖标准误)、BGCV,(血糖变异系数)、IMS(普通胰岛素用量)、IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(干扰素-a)均有统计学差异(P0.05)。4、经两独立样本t检验：胰岛素抵抗组和胰岛素不抵抗组IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干扰素-α)均有统计学差异(P0.05)。5、经简单线性相关分析：HOMA-Rl：胰岛素抵抗指数)和IL-1(白介素-1)有相关性(P0.001, r=0.637)、HOMA-R(胰岛素抵抗指数)和IL-6(白介素-6)有相关性(P0.001, r=0.664)、HOMA-Ri(胰岛素抵抗指数)和IL-8(白介素-8)有相关性(P0.001, r=0.574)、HOMA-R(胰岛素抵抗指数)和IFN-α(干扰素-α)有相关性(P0.001,r=0.844)。结论1、组合式血液净化模式对MODS患者胰岛素抵抗疗效优于单一血液净化模式(CVVH)。2、组合式血液净化模式对MODS患者血液中炎性介质清除率高于单一血液净化模式(CVVH),胰岛素抵抗组血液中炎性介质高于胰岛素不抵抗组。3、胰岛素抵抗指数和血液中炎性介质(IL-1、IL-6、IL-8、IFN-α)具有正相关性。
[Abstract]:Objective to study the combined mode of blood purification on clinical efficacy of insulin resistance in patients with MODS, improve insulin resistance of MODS patients to explore the best mode of blood purification for patients with MODS and clarify the possible mechanism of insulin resistance. Methods 60 cases of MODS patients were randomly divided into single mode of blood purification (continuous veno venous hemofiltration) and the combined mode of blood purification group (continuous veno venous hemofiltration hemoperfusion), 30 cases in each group, to observe the basic situation of the two groups of patients: age, gender, within 24 hours after admission APACHE score, SOFA score within 24 hours of hospitalization, collected before treatment, after treatment 7 d clinical indexes: FBG (fasting blood glucose) HbA1c, (HbA1c), FINS (fasting insulin (CRP), C- HOMA-IR (C-reactive protein), insulin resistance index (BG), BGSD BGcv (standard deviation), BG IL-1 (coefficient of variation), interleukin -1, interleukin - (IL-6) 6 (IL-8), interleukin -8 (IFN-), alpha interferon alpha), according to HOMA-IR after treatment (insulin resistance index) of 2.69 groups were divided into treatment and treatment of insulin resistance after insulin resistance group and IL-1 were compared between the two groups (IL -1), IL-6 (interleukin -6 (IL-8). Interleukin -8 (TNF-), alpha interferon alpha) whether there are differences, packet data entry using Epidata 3.02 software, dual input method input to the test data, the two data correct after verification, the data were analyzed with relevant professional using spss20.0 statistical software. Results of the 1, the two independent sample t test: the test group and the control group in age, APACHE score, SOFA score were not statistically significant (P0.05), the four table 2 test: the test group and the control group there was no significant difference in gender (P=0.301): experimental group and control group before treatment FBG (fasting blood glucose), FINS (fasting insulin), HOMA-IR (pancreatic 宀涚礌鎶垫姉鎸囨暟),BGSD(绌鸿吂琛，

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