A. Ayla KABALAK, Ayşegül CEYLAN, Çağıl VURAL

Effect of insulin treatment to systemic ınflammatory response in burn ınjury

Amaç: Sistemik inflamatuvar ve hepatik akut faz yanıtı hipermetabolizmaya, çoklu organ yetmezliğine ve mor- taliteye katkıda bulunur. Bu çalışmada, ciddi biçimde yanmış ve kan şekeri düzeyleri normal sınırlarda olan hastalarda, insulin verilen ve verilmeyen grupları karşı- laştırarak insülinin sistemik inflamatuvar yanıta, pro-inf- lamatuar proteinlere ve hepatik akut faz yanıta etkilerini incelemeyi amaçladık. Materyal ve Metot: Oniki yanık hastasına kan şekeri düzeyini 120-180 mg/dl aralığında tutmak için insulin verilirken, kontrol grubundaki kan şekeri düzeyleri 120- 180 mg/dl arasında olan 11 hastaya insulin verilmedi. Ölçümlerimiz, insülinin pro-inflamatuvar proteinlere, yağa ve hepatik akut faz yanıtına etkilerini kapsadı. Bulgular: ønsülin uygulaması, pro-inflamatuvar protein- leri azaltırken hepatik proteinleri artırdı (p

(Yanıkta insülin tedavisinin sistemik inflamatuar yanıt üzerindeki etkileri)

Background: The systemic inflammatory and hepatic acute-phase-response contributes to hypermetabolism, multi-organ failure, and mortality. We aimed the effect of insulin on the systemic inflammatory response, pro- inflammatory proteins, and hepatic acute-phase- response in severely burned patients that received insulin but had glucose levels in the normal range, and compared the findings to patients who had similar glucose levels but did not receive insulin. Material and Methods: Twelve burn injured patients received insulin to maintain blood glucose at a range from 120 to 180 mg/dl, 11 patients received no insulin with blood glucose levels also at range from 120 to 180 mg/dl and served as controls. Our outcome measures encompassed the effect of insulin on pro-inflammatory proteins, the hepatic acute-phase-response, and fat. Results: Insulin administration decreased pro-inflam- matory proteins, while increasing hepatic proteins (P<0.05). Burned patients receiving insulin required significantly less albumin substitution to maintain normal levels compared with control (P<0.05). Insulin decreased serum triglycerides (P<0.05). Incidence of sepsis and length of hospital stay decreased with insulin administration (P<0.05). Conclusions: Insulin attenuates the inflammatory res- ponse by decreasing the pro-inflammatory, thus resto- ring hepatic functions. Therefore, we suggest that insulin may decrease morbidity and mortality in burn patients.

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