Abnormal Insulin Sensitivity Persists up to Three Years in Pediatric Patients Post-Burn

被引:133
作者
Gauglitz, Gerd G.
Herndon, David N. [2 ]
Kulp, Gabriela A.
Meyer, Walter J., III [3 ]
Jeschke, Marc G. [1 ,2 ]
机构
[1] Shriners Hosp Children, Galveston Burns Unit, Galveston, TX 77550 USA
[2] Univ Texas Galveston, Med Branch, Dept Surg, Galveston, TX 77555 USA
[3] Univ Texas Galveston, Med Branch, Dept Psychiat, Galveston, TX 77555 USA
基金
美国国家卫生研究院;
关键词
SEVERE BURN INJURY; CRITICALLY-ILL PATIENTS; SKELETAL-MUSCLE; HYPERMETABOLIC RESPONSE; ENERGY-EXPENDITURE; GLUCOSE CONTROL; OBESE CHILDREN; HYPERGLYCEMIA; RESISTANCE; CATABOLISM;
D O I
10.1210/jc.2008-1947
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: The acute hypermetabolic response post-burn is associated with insulin resistance and hyperglycemia, significantly contributing to adverse outcome of these patients. Objective: The aim of the study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree of insulin resistance in severely burned children for up to 3 yr after the burn injury. Design, Setting and Patients: A total of 194 severely burned pediatric patients, admitted to our institute between 2002 and 2007, were enrolled in this prospective study and compared to a cohort of 95 nonburned, noninjured children. Main Outcome Measures: Urinary cortisol, epinephrine, and norepinephrine, serum cytokines, and resting energy requirements were determined at admission and 1, 2, 6, 9, 12, 18, 24, and 36 months post-burn. A 75-g oral glucose tolerance test was performed at similar time points; serum glucose, insulin, and C-peptide were measured; and insulin sensitivity indices, such as ISI Matsuda, homeostasis model assessment, quantitative insulin sensitivity check index, and ISI Cederholm, were calculated. Statistical analysis was performed by ANOVA with Bonferroni correction with significance accepted at P < 0.05. Results: Urinary cortisol and catecholamines, serum IL-7, IL-10, IL-12, macrophage inflammatory protein-1b, monocyte chemoattractant protein-1, and resting energy requirements were significantly increased for up to 36 months post-burn (P < 0.05). Glucose values were significantly augmented for 6 months post-burn (P < 0.05), associated with significant increases in serum C-peptide and insulin that remained significantly increased for 36 months compared to nonburned children (P < 0.05). Insulin sensitivity indices, ISI Matsuda, ISI quantitative insulin sensitivity check index, and homeostasis model assessment were abnormal throughout the whole study period, indicating peripheral and whole body insulin resistance. The insulinogenic index displayed physiological values, indicating normal pancreatic beta-cell function. Conclusions: A severe burn is associated with stress-induced insulin resistance that persists not only during the acute phase but also for up to 3 yr post-burn. (J Clin Endocrinol Metab 94: 1656-1664, 2009)
引用
收藏
页码:1656 / 1664
页数:9
相关论文
共 62 条
[1]   Oral glucose load inhibits circulating ghrelin levels to the same extent in normal and obese children [J].
Baldelli, R ;
Bellone, S ;
Castellino, N ;
Petri, A ;
Rapa, A ;
Vivenza, D ;
Bellone, J ;
Broglio, F ;
Ghigo, E ;
Bona, G .
CLINICAL ENDOCRINOLOGY, 2006, 64 (03) :255-259
[2]   Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview [J].
Capes, SE ;
Hunt, D ;
Malmberg, K ;
Gerstein, HC .
LANCET, 2000, 355 (9206) :773-778
[3]   Insulin resistance and glucose-induced thermogenesis in critical illness [J].
Carlson, GL .
PROCEEDINGS OF THE NUTRITION SOCIETY, 2001, 60 (03) :381-388
[4]   Insulin resistance following thermal injury: An animal study [J].
Chen, Xin-Lony ;
Xia, Zhao-Fan ;
Ben, Dao-Feng ;
Tian, Jian-Guang ;
Wei, Duo .
BURNS, 2007, 33 (04) :480-483
[5]   p38 mitogen-activated protein kinase inhibition attenuates burn-induced liver injury in rats [J].
Chen, XL ;
Xia, ZF ;
Yu, YX ;
Wei, D ;
Wang, CR ;
Ben, DF .
BURNS, 2005, 31 (03) :320-330
[6]   Hyperglycaemia and mortality in critically ill patients - A prospective study [J].
Christiansen, C ;
Toft, P ;
Jorgensen, HS ;
Andersen, SK ;
Tonnesen, E .
INTENSIVE CARE MEDICINE, 2004, 30 (08) :1685-1688
[7]   URINE CORTISOL-LEVELS AFTER BURN INJURY [J].
COOMBES, EJ ;
BATSTONE, GF .
BURNS, 1982, 8 (05) :333-337
[8]   Postburn trauma insulin resistance and fat metabolism [J].
Cree, Melanie G. ;
Wolfe, Robert R. .
AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, 2008, 294 (01) :E1-E9
[9]   Insulin sensitivity and mitochondrial function are improved in children with burn injury during a randomized controlled trial of fenofibrate [J].
Cree, Melanie G. ;
Zwetsloot, Jennifer J. ;
Herndon, David N. ;
Qian, Ting ;
Morio, Beatrice ;
Fram, Ricki ;
Sanford, Arthur P. ;
Aarsland, Asle ;
Wolfe, Robert R. .
ANNALS OF SURGERY, 2007, 245 (02) :214-221
[10]  
DEFRONZO RA, 1979, AM J PHYSIOL, V237, pE214