了解重度烧伤应激后患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、T淋巴细胞亚群的变化，探讨胰岛素强化治疗对重度烧伤患者炎症反应与免疫功能的影响。

选取2012年3月至2015年12月内蒙古医科大学第三附属医院烧伤科收治的重度烧伤患者56例，按随机数字表法分为胰岛素强化治疗组与常规治疗组，每组各28例，采用静脉输液泵持续静脉泵入胰岛素(50 IU胰岛素加入到50 mL 0.9%氯化钠溶液中)，依据患者血糖测定结果指导治疗。胰岛素强化治疗组血糖水平控制在4.4～7.0 mmol/L；常规治疗组血糖水平控制在7.0～10.0 mmol/L。分别在治疗后即刻及治疗后第3、7、14、21天后测定患者的血清TNF-α、IL-6含量和外周血中CD3^＋、CD4^＋、CD8^＋及CD4^＋/CD8^＋比值变化情况；记录两组患者治疗后21 d血、尿、痰培养及创面培养阳性感染人数并计算感染率。数据采用单因素重复测量方差分析、t检验及χ²检验。

两组患者在治疗后血清TNF-α、IL-6含量均逐渐降低，差异均有统计学意义(P值均小于0.05)；在治疗后第7、14、21天，胰岛素强化治疗组患者血清TNF-α含量分别为(841.40±340.87)、(588.99±238.61)、(518.23±227.41) pg/mL，均低于常规治疗组(1068.19±452.38)、(739.81±283.31)、(662.91±250.77) pg/mL，差异均有统计学意义(t＝2.12、2.16、2.26，P＝0.039、0.036、0.028)；在治疗后第7、14、21天，胰岛素强化治疗组血清IL-6含量分别为(754.88±325.72)、(329.02±159.44)、(242.53±117.16) pg/mL，均低于常规治疗组(990.01±443.83)、(424.81±161.02)、(310.38±119.54) pg/mL，差异均有统计学意义(t＝2.26、2.24、2.15，P＝0.028、0.029、0.036)。治疗后两组患者的外周血CD3^＋、CD4^＋、CD8^＋细胞的百分比及CD4^＋/CD8^＋比值均有所升高，差异均有统计学意义(P值均小于0.05)；两组患者的CD3^＋、CD4^＋、CD8^＋细胞的百分比在各个时间点比较，差异均无统计学意义(P值均大于0.05)；在治疗后第14、21天，胰岛素强化治疗组CD4^＋/CD8^＋比值分别为1.27±0.37、1.31±0.37，均高于常规治疗组1.08±0.31、1.12±0.32，差异均有统计学意义(t＝2.03、2.08，P＝0.047、0.043)；胰岛素强化治疗组患者的感染率为14.3%(4/28)，显著低于常规治疗组39.3%(11/28)，差异有统计学意义(χ²＝4.46，P<0.05)。

胰岛素强化治疗可以更好地抑制重度烧伤患者体内的炎症反应，提高患者的免疫功能，降低感染率。

To investigate the changes of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and T lymphocyte subsets in severe burn patients with stress induced and to explore the effect of intensive insulin therapy on inflammatory response and immune function in severe burn patients.

Fifty-six patients with severe burn from March 2012 to December 2015 in the Department of Burns, Third Affiliated Hospital of Inner Mongolia Medical University were enrolled. They were divided into intensive insulin therapy group and conventional therapy group according to the random digital table method, 28 cases in each group. Continuous intravenous pump of insulin (50 IU of insulin added to 50 mL of 0.9% sodium chloride solution) was used to guide therapy based on patients′ glucose measurements. The blood glucose levels in intensive insulin therapy group, were controlled at 4.4-7.0 mmol/L and conventional therapy group were controlled at 7.0-10.0 mmol/L. The levels of serum TNF-α, IL-6 and peripheral blood CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺ were measured at 3rd, 7th, 14th and 21st day after treatment. The number of positive infection of blood, urine, sputum culture and wound culture in 21 days of treatment were recorded and the infection rate was calculated. The data were analyzed by analysis of variance of repeated measurement, t test and chi-square test.

After treatment, the levels of TNF-α and IL-6 in both groups gradually decreased, the differences were statistically significant (with P values below 0.05). The levels of TNF-α in the intensive insulin therapy group were (841.40 ± 340.87), (588.99 ± 238.61), (518.23±227.41) pg/mL respectively on the 7th, 14th and 21st day after treatment, lower than those in the conventional therapy group (1068.19 ± 452.38), (739.81±283.31), (662.91±250.77) pg/mL respectively, the differences were statistically significant (t=2.12, 2.16, 2.26; P=0.039, 0.036, 0.028). The levels of IL-6 in the intensive insulin therapy group were (754.88 ± 325.72), (242.53 ± 117.16), (242.53±117.16) pg/mL respectively on the 7th, 14th and 21st day after treatment, lower than those in the conventional therapy group (990.01±443.83), (424.81±161.02), (310.38±119.54) pg/mL respectively, the differences were statistically significant (t=2.26, 2.24, 2.15; P=0.028, 0.029, 0.036). After treatment, the percentages of CD3⁺, CD4⁺, CD8⁺ cells and CD4⁺/CD8⁺ in the peripheral blood of the two groups increased, with differences statistical significance(with P values below 0.05). The percentages of CD3⁺, CD4⁺ and CD8⁺ cells in both groups were compared at various time points, the differences were statistically significant(with P values below 0.05). On the 14th and 21st day after treatment, the ratios of CD4⁺ and CD8⁺ were 1.27 ± 0.37, 1.31 ± 0.37, respectively higher than those of the conventional therapy group 1.08 ± 0.31, 1.12 ± 0.32, the differences were statistically significant(t=2.03, 2.08; P=0.047, 0.043). The infection rate in intensive insulin therapy group was 14.3% (4/28), which was significantly lower than that in conventional therapy group 39.3%(11/28), the difference was statistically significant (χ²=4.46, P<0.05).

Intensive insulin therapy can better inhibit the inflammatory response in the patients with severe burn, improve the immune function of the patients and reduce the infection rate.