Abnormal Insulin Sensitivity Persists up to Three Years in Pediatric Patients Post-Burn
Abnormal Insulin Sensitivity Persists up to Three Years in Pediatric Patients Post-Burn
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DOI：
10.1210/jc.2008-1947
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发表时间：
2009-05-01
影响因子：
5.8
通讯作者：
Jeschke, Marc G.
中科院分区：
文献类型：
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作者：
Gauglitz, Gerd G.;Herndon, David N.;Jeschke, Marc G.
内容：烧伤后的急性高代谢反应与胰岛素抵抗和高血糖症有关，这对这些患者的不良结局有显著影响。目的：本研究的目的是检查各种临床参数异常的持续性，这些参数通常用于评估严重烧伤儿童在烧伤后长达3年的胰岛素抵抗程度。设计、设置和患者：本前瞻性研究共纳入了2002年至2007年间在我院住院的194例严重烧伤儿童患者，并与95例未烧伤、未受伤儿童进行了比较。在入院时和入院后1、2、6、9、12、14、16、17、18、19、20、21、22、24、25、26、27、28、29烧伤后18、24和36个月。在相似的时间点进行75 g口服葡萄糖耐量试验;测量血清葡萄糖、胰岛素和C肽;计算胰岛素敏感性指数，如ISI Matsuda、稳态模型评估、定量胰岛素敏感性检查指数和ISI Cederholm。结果：烧伤后36个月，尿皮质醇、尿儿茶酚胺、血清IL-7、IL-10、IL-12、巨噬细胞炎性蛋白-1b、单核细胞趋化蛋白-1和静息能量需求均显著升高（P < 0.05）。烧伤后6个月血糖值显著升高（P < 0.05），与此相关的是血清C肽和胰岛素显著升高，与非烧伤儿童相比，血清C肽和胰岛素持续升高36个月（P < 0.05）。在整个研究期间，胰岛素敏感性指数、ISI Matsuda、ISI定量胰岛素敏感性检查指数和稳态模型评估均异常，表明外周和全身胰岛素抵抗。胰岛素生成指数显示生理值，表明正常的胰腺β细胞function.Conclusions：严重烧伤与应激诱导的胰岛素抵抗，不仅持续在急性期，但也为长达3年烧伤后。（临床内分泌代谢杂志94：1656-1664，2009）
Context: The acute hypermetabolic response post-burn is associated with insulin resistance and hyperglycemia, significantly contributing to adverse outcome of these patients.Objective: The aim of the study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree of insulin resistance in severely burned children for up to 3 yr after the burn injury.Design, Setting and Patients: A total of 194 severely burned pediatric patients, admitted to our institute between 2002 and 2007, were enrolled in this prospective study and compared to a cohort of 95 nonburned, noninjured children.Main Outcome Measures: Urinary cortisol, epinephrine, and norepinephrine, serum cytokines, and resting energy requirements were determined at admission and 1, 2, 6, 9, 12, 18, 24, and 36 months post-burn. A 75-g oral glucose tolerance test was performed at similar time points; serum glucose, insulin, and C-peptide were measured; and insulin sensitivity indices, such as ISI Matsuda, homeostasis model assessment, quantitative insulin sensitivity check index, and ISI Cederholm, were calculated. Statistical analysis was performed by ANOVA with Bonferroni correction with significance accepted at P < 0.05.Results: Urinary cortisol and catecholamines, serum IL-7, IL-10, IL-12, macrophage inflammatory protein-1b, monocyte chemoattractant protein-1, and resting energy requirements were significantly increased for up to 36 months post-burn (P < 0.05). Glucose values were significantly augmented for 6 months post-burn (P < 0.05), associated with significant increases in serum C-peptide and insulin that remained significantly increased for 36 months compared to nonburned children (P < 0.05). Insulin sensitivity indices, ISI Matsuda, ISI quantitative insulin sensitivity check index, and homeostasis model assessment were abnormal throughout the whole study period, indicating peripheral and whole body insulin resistance. The insulinogenic index displayed physiological values, indicating normal pancreatic beta-cell function.Conclusions: A severe burn is associated with stress-induced insulin resistance that persists not only during the acute phase but also for up to 3 yr post-burn. (J Clin Endocrinol Metab 94: 1656-1664, 2009)