Changes in Insulin Resistance and Gastrointestinal Microbiology in Patients with Traumatic Syndrome

BACKGROUND: It is known that one of the basic processes developing in response to injury is insulin resistance. The mechanisms of development of insulin resistance at the present stage are not fully disclosed. There is an increasing amount of evidence indicating the role of the gastrointestinal microbiota in the development of insulin resistance.

AIM: Was to evaluate the dynamics of the triglyceride-glucose index in relation to the taxonomic composition of the microbiota of the gastrointestinal tract and blood in patients with combined musculoskeletal injury.

METHODS: 44 wounded with combined injury of the musculoskeletal system who were being treated at the clinic of military field surgery of the Military Medical Academy named after S.M. Kirov were examined. The patients underwent a standard examination with the calculation of an indirect indicator of insulin resistance, the triglyceride-glucose index. The microbiota of feces and blood was studied by sequencing 16S ribosomal ribonucleic acid.

RESULTS: The average value of the triglyceride-glucose index in the victims was 4.61 ± 0.22 units. In 79.5% of patients, the value of the triglyceride-glucose index exceeded 4.49 units, which indicates the presence of signs of insulin resistance. There were direct correlations of the triglyceride-glucose index with the level of total cholesterol, serum amylase, the presence of chronic pancreatitis, and a number of ultrasound parameters of the liver, gallbladder, and pancreas. The most significant direct links of the triglyceride-glucose index were established with the presence of Pseudoscardovia, Pyramidobacter, and Pediococcus in the intestinal microbiota, and with bacteria of the genera Bacillus and Pseudomonas in the blood serum. Moderate inverse associations of the triglyceride-glucose index with the presence of bacteria of the genera Scardovia, Actinomyces, and Allofournierella (synonym: Fournierella) in the feces were revealed, Butyricicoccaceae UCG-009, Lactobacillus crispatus wiggsiae not Scardovia species, In. blood serum — bacteria Bifidobacterium Rodova, Phascolarctobacterium, Hydrogenophilus, the type of Escherichia is not Phascolarctobacterium albertii faecium.

CONCLUSION: The established trends in the nature of changes in insulin resistance, depending on the timing of combat injury, indicate the dynamics of insulin resistance associated with the course of traumatic illness. Insulin resistance in the early period of traumatic illness, which develops in response to stress, blood loss, and tissue damage, can be considered as a compensatory and adaptive response within the framework of the concept of general adaptation syndrome, aimed primarily at eliminating energy deficiency. Therefore, it is necessary to conduct further research that can expand the understanding of the role of the bacterial microbiota as an important component of the gastrointestinal tract biotech complex in the development of metabolic changes in patients with injuries, as well as methods for their correction.