脓毒症对患儿胰腺β细胞功能影响研究

许锦姬+洪先欧+池卡+刘纯义

[摘要] 目的 观察脓毒症患儿体内的胰腺功能改变，评估脓毒症对患者胰腺β细胞功能影响。方法 收集脓毒症、严重脓毒症、脓毒性休克患儿及健康对照患儿各30例，于治疗前及治疗后分别抽取静脉血检测患儿的空腹时的胰岛素、C肽、血糖水平，比较组间差异及治疗前后差异。结果 治疗前4组患儿胰岛素、C肽、血糖水平两两存在差异，病情越严重，胰岛素、C肽、血糖水平水平越高；而存在脓毒症的3组患儿治疗前后差异有统计学意义（P<0.05）。结论 脓毒症改变患儿体内炎症因子，损害胰腺β细胞功能，从而改变了患儿体内胰岛素、C肽、血糖水平，经过及时抢救及治疗可使其好转。

[关键词] 脓毒症；胰腺β细胞；胰岛素；C肽

[中图分类号] R725.8 [文献标识码] A [文章编号] 2095-0616（2017）20-66-03

Study on the effect of sepsis on the function of pancreatic beta cells in children

XU Jinji HONG Xian'ou CHI Ka LIU Chunyi

Department of Pediatrics， Baoan District Maternal and Child Health Hospital of Shenzhen City， Shenzhen 518000， China

[Abstract] Objective To observe the change of pancreatic function in children with sepsis and evaluate the effect of sepsis on the function of pancreatic beta cells in patients. Methods 30 cases respectively of sepsis， severe sepsis， septic shock and healthy control of children were selected， after treatment and after treatment， the fasting insulin， C peptide， blood glucose levels of venous blood of all patients were detected and the differences were compared between four groups and before and after treatment. Results The fasting insulin， C peptide， blood glucose levels of patients was different between in the four groups before treatment， the more serious the condition， the higher the fasting insulin， C peptide， blood glucose levels. There was a difference between the three groups of children with sepsis， P<0.05， which was statistically significant. Conclusion Sepsis changes the inflammation factor in the children and damages the function of the beta cell of the pancreas， thus altering the fasting insulin， C peptide， blood glucose levels in children， which can be improved by timely rescue and treatment.

[Key words] Sepsis； Pancreatic beta cells； Insulin； C peptide

膿毒症患儿病情严重，进展迅速，病死率较高[1]。脓毒症对身体多器官均可产生损伤，其中对胰岛功能的损伤越来越受到关注[2]。脓毒症患儿常出现高血糖表现，并且较难达到10mmol/L以下的理想状况[3]。重症患儿发生胰腺损害的机制与细菌发生移位、内毒素血症、缺血再灌注损伤、血管损伤和血栓形成、代谢抑制等有关系，但其具体机制尚不清楚；更多了解脓毒症患儿胰腺β细胞功能的改变，可以更好地研究其发病机制，寻找治疗脓毒症对胰岛功能损伤的方法。本研究通过对脓毒症患儿血清胰岛素、C肽及血糖改变的观察，以评估对脓毒症胰岛功能的影响。

1 资料与方法

1.1 一般资料

选取2014年7月～2016年7月，本院儿科及

重症监护室住院的脓毒症患儿共90例，根据中国严重脓毒症/脓毒性休克治疗指南（2014）诊断标准[3]，分为脓毒症组、严重脓毒症组、脓毒性休克及对照组各30例，这些患儿中，原发病为肺炎41例，腹部感染31例，泌尿系感染12例，皮肤软组织感染20例，颅内感染16例。……