胰岛素治疗对支气管哮喘急性发作期病程的影响
2015/12/03
摘要
全身大剂量糖皮质激素是支气管哮喘急性发作治疗的基础。全身应用糖皮质激素引起的高糖状态，可导致糖尿病过早发病或哮喘急性发作治疗期间糖尿病的首次确诊。本研究为前瞻性、随机研究，纳入24例哮喘急性发作的成人患者，且入院时血糖均大于8.4 mmol/l。随机分为A和B组，A组给予电子注射泵静脉滴注胰岛素，血糖控制目标为4.5-7.2 mmol/l；B组则给予皮下注射胰岛素，分三次进行，血糖目标为7.2-10.0 mmol/l。C组为对照组，纳入对象为不伴任何糖代谢紊乱的哮喘急性发作患者。三组急性发作期的哮喘患者均采用同样的治疗方案。结果发现：A组平均住院时间为8.2 ± 2.4天，B组为10.2 ± 5.2天，C组为5.8 ± 1.9天，C组患者平均住院时间显著低于A与B组。因此，可以得出如下结论：无论采用哪种胰岛素治疗方式，高血糖是增加哮喘急性发作期住院时间的一个重要因素。
（杨冬 审校）
Adv Exp Med Biol. 2015 Oct 10. [Epub ahead of print]
The Influence of Insulin Therapy on the Course of Acute Exacerbation of Bronchial Asthma.
Wytrychowski K1, Obojski A2, Hans-Wytrychowska A3.
Abstract
Large doses of systemic corticosteroids are the basis of treatment of acute exacerbation of bronchial asthma. The hyperglycemic activity of systemic corticosteroids often leads to the loss of control of diabetes diagnosed earlier or to its first diagnosis during treatment of the exacerbation of asthma. We conducted a prospective, randomized study in a group of 24 adult patients treated for asthma exacerbation, with the blood glucose level at admission above 8.4 mmol/l. The patients were randomly divided into a group treated with intravenous insulin infusion by an electric syringe pump in doses controlling glycemia at 4.5-7.2 mmol/l (Group A) and a group of patients treated with insulin administered subcutaneously in three doses controlling glycemia at 7.2-10.0 mmol/l (Group B). A control group (Group C) consisted of patients without any disturbances in carbohydrate metabolism, treated for exacerbation of asthma. Asthma exacerbation was treated in all groups in a uniform way. We found that the average hospitalization time was 8.2 ± 2.4 days in Group A, 10.2 ± 5.2 days in Group B, and 5.8 ± 1.9 days in Group C; the last being significantly shorter than those in Groups A and B. We conclude that hyperglycemia is a significant factor increasing the risk of extending hospitalization time due to asthma exacerbation, regardless of the way of insulin therapy.
Adv Exp Med Biol. 2015 Oct 10. [Epub ahead of print]
