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目的 探讨胰岛素抵抗和胰岛素分泌功能变化在创伤失血多器官功能不全综合征 (MODS)中的临床意义。方法 观察创伤失血MODS患者稳态模式评估法胰岛素抵抗指数 (HOMA -IR) ,胰岛素分泌指数 (HOMA - β)、空腹血糖、空腹乳酸、空腹乳酸和丙酮酸比值等的变化 ,并对MODS主要器官功能指标 ,细胞氧化水平指标与HOMA -IR指数进行相关和回归分析。结果 创伤失血MODS组HOMA -IR指数、乳酸、乳酸和丙酮酸比值 ,胰高血糖素和皮质醇等含量均明显高于正常对照组 (P <0 .0 1) ,HOMA - β指数明显低于正常对照组。创伤失血MODS严重程度与HOMA -IR指数明显正相关 (P <0 .0 1)。结论 测定HOMA -IR指数和HOMA - β指数可作为MODS患者转归 ,预后的预警指标。
Objective To investigate the clinical significance of changes in insulin resistance and insulin secretion in traumatic hemorrhage with multiple organ dysfunction syndrome (MODS). Methods The changes of HOMA-IR, HOMA - β, fasting blood glucose, fasting lactate, fasting lactate and pyruvate ratio in patients with traumatic hemorrhage and MODS were observed. The changes of major organs The indexes of function and the level of cellular oxidation correlated with HOMA-IR index and regression analysis. Results HOMA-IR index, lactate, lactate and pyruvate ratio, glucagon and cortisol were significantly higher in MODS group than those in normal control group (P0.01), and the HOMA - β index was significantly lower than that in normal control group Normal control group. The severity of traumatic bleed MODS was positively correlated with HOMA-IR index (P <0.01). Conclusion The determination of HOMA-IR index and HOMA - β index may be used as early warning indicators of outcome and prognosis in patients with MODS.