Influence of Intensive Insulin Therapy on Vascular Endothelial Growth Factor in Patients with Severe Trauma

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 33; no. 1; pp. 107 - 110
• Main Author: 赵晓东 秦宇红 马俊勋 党伟 王曼 张宪 刘红升 张建波 姚咏明 张连阳 苏琴
• Format: Journal Article
• Language: English
• Published: Heidelberg Huazhong University of Science and Technology 01.02.2013; Emergency Department, the First Affiliated Hospital of PLA General Hospital, Beijing 100048, China
• Subjects: Adult; ELISA法; Endothelin-1 - blood; Female; Humans; Hyperglycemia - blood; Hyperglycemia - diagnosis; Hyperglycemia - drug therapy; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Male; Medicine; Medicine & Public Health; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Vascular Endothelial Growth Factor A - blood; Wounds and Injuries - blood; Wounds and Injuries - diagnosis; Wounds and Injuries - drug therapy; 创伤; 强化; 患者; 放射免疫测定法; 治疗; 胰岛素; 血管内皮生长因子; intensive insulin therapy; endothelin-1; severe trauma; vascular endothelial growth factor; endothelial cell
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-013-1080-4

The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication were investigated. Sixty-four cases of severe trauma （injury severity score 〉20） with stress hyperglycemia （blood glucose 〉9 mmol/L） were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient grada- tion one-step process were used to determine plasma VEGF, endothelin-1 （ET-1）, and the number of circulating endothelial cells （CECs） at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF （ng/L）, 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P〈0.05, 0.01, 0.05, 0.05 respectively; for ET-1 （ng/L）, 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P〈0.05, 0.01, 0.01, 0.01 respectively; for CRP （mg/L）, 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P〈0.05; for CECs （/0.9 μL）, 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P〈0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.