THE ASSOCIATION STUDY OF HEAD INJURY AND INSULIN RESISTANCE ABSTRACT Background and Purpose: Head injury is one of the common forms of trauma seen clinically. With the development of transport, sport injuries, accidents, natural disasters, and many other factors, the incidence of head injury has been sustained. Head injury accounts for 10 -15% of total body trauma among severe and special severe brain injury. The mortality rate in those cases is between 36.8-64.3% Although medical technology is constantly increasing, even though much prevention, rescue measures, has been undertaken, brain injury is still one of the leading causes of disability and patients’ death. Patients with brain injury often have a series of metabolic disorders, notably insulin resistance. In recent years, insulin resistance (insulin resistance, IR) has been a focal point in clinical research; studies have shown that insulin resistance is widespread in a variety of pathological conditions, it is a common risk factor in many disease. We have had a consensus for insulin resistance after head injury. Brain injury during acute state is associated with a stress response which includes hyperglycemia and insulin resistance. It is involved with multiple factors, the mechanisms which are underlying this is relatively complicated. In recent years, the blood glucose metabolism changed after brain injury, and their clinical role significance has aroused the attention of many scholars. The intensity of stress response in patients with brain injury during acute state can directly affect their prognosis. Consequently preventing insulin resistance, reduce hyperglycemia, explore the role of insulin resistance (IR) and hyperglycemia, and knowing their prognostic factors. The correct management is the focal point for clinicians to improve outcome and to reduce morbidity and mortality of patients with head injury. Our aim of this study is to analyze the severity of head injury (Glasgow Coma Score, GCS), changes of blood glucose and insulin values, and their relationship with outcome among the patients with head injury. Methods: In this study 92 patients with head injury were admitted to Renji Hospital, which is affiliated with Shanghai JiaoTong University School of Medicine (Shanghai, China) from Jun 2004 until Dec 2005. These patients were evaluated at time of admission according to the severity of head injury (Glasgow Coma Score, GCS) and divided into three groups; light (GCS13-15) 38 patients, medium (GCS9-12) 30 patients, and severe(GCS≤8) 24 patients. We determined fasting blood glucose levels (FBG) and fasting serum insulin levels (FINS) at 24 hours, 48 hours, and 72 hours respectively, while having the insulin resistance index (HOMA, IR) calculated. At the time of patients discharge the patients prognosis was estimated based on GOS standards. Using SPPS 11.5 Statistical Software for Data Processing, the analysis of GCS, FBG, FINS values, and the relationship with GOS (Glasgow Outcome Score standards) were taken under measure. Results: In our study, a group of 92 patients with head injury were admitted and tested. The blood glucose and insulin monitoring in the light, medium, and severe groups of patients admitted showed significant differences (P<0.01). As the blood glucose rose, the condition gradually worsened, and the GCS declined with statistical significance (P<0.01); which shows that the range of FBG increase was proportional with the severity of brain injury and proportional with GCS score. At the time of a patients discharge, the patient’s prognosis established based on GOS standards, shows the more the value of Homa IR increase, the poorer the prognosis. Conclusion: The data shows that the severity and prognosis of head trauma is closely related to the FBG and Homa IR value. The effect of insulin resistance induced hyperglycemia in patients with brain injury is relatively high, therefore if discovered early and controlled it can greatly change the patients outcome. KEY WORDS: Head injury, insulin resistance, hyperglycemia Humaid Yahya ,Cui Hua, Wang Yong . Head Trauma and Insulin Resistance. Journal Of International Neurology and Neurosurgery ，2005，32（6）：540-542.