肠屏障功能障碍临床评估指标建立的初步研究  

A pilot study on establishment of clinical evaluation system for gut barrier dysfunction

作　　者：黄晓曦[1] 王兴鹏[1] 吴恺[1] 马晶晶[1] 徐铭益[1] 

机构地区：[1]上海市第一人民医院消化科,200080

出　　处：《中华消化杂志》2006年第8期519-522,共4页Chinese Journal of Digestion

摘　　要：目的探讨肠屏障功能的影响因素,并初步建立临床评估方法。方法选取53例重症监护的危重病患者(APACHEⅡ评分≥8分)及27例同期住院患者(APACHEⅡ评分≤6分),记录其病史特点、临床症状、体征,并检测血浆内毒素、肿瘤坏死因子-α、二胺氧化酶、D-乳酸、高敏C反应蛋白,尿液乳果糖/甘露醇(L/M)排出比值、尿液肠脂肪酸结合蛋白(IFABP)等指标。所得资料在单因素分析基础上,用Logistic回归进行多因素分析,筛选与肠屏障功能障碍关系密切的因素,然后用受试者工作曲线确定最佳临界点和可疑值范围。结果肠屏障功能障碍与多种因素有关。其中尿L/M比值、24 h尿液IFABP含量、血浆内毒素水平与肠屏障功能障碍的发生明显相关。以尿L/M比值、24 h尿液IFABP含量、血浆内毒素水平推测肠屏障功能障碍的受试者工作曲线下面积分别为0．85、0．78和0．76(P值均＜0．05)。尿L/M比值的最佳临界点为0．145,诊断肠屏障功能障碍的敏感性为84．5％,特异性为88％。可疑值范围为(0．178,0．082)。24 h尿液IFABP含量和血浆内毒素水平的受试者工作曲线最佳临界点分别为17 ng和0．055 EU/ml,敏感性分别为78％和78％,特异性分别为88％和78％。结论危重患者在原发病基础上出现消化系统症状、体征,并有肠道通透性增加(L/M＞0．178)、肠道低灌注(尿液24 h IFABP＞17 ng)及血浆内毒素水平增高(＞0．055 EU/ml)时可能发生肠屏障功能障碍。Objective To investigate the potential influencing factors which possibly effected the gut barrier function. The effort was made to establish a clinical evaluation system of gut barrier dysfunction. Methods Fifty-three critically ill patients with an APACHE Ⅱ score of 8 or more and 27 patient which APACHE Ⅱ score was 6 or less were recruited. Plasma was reserved for measurement of endotoxin, tumor necrosis factor -α, diamine oxidase, D-lactic acid and high-sensitive C reactive protein, urinary excretion of lactulose and mannitol and the urinary content of intestinal fatty acid binding protein （IFABP） were determined as well. Analyses was achieved by univariate, multivariate analysis and receiver operating characteristic curve. Results In the logistic regression models, gut barrier was affected by many factors. The ratio of lactulose and mannitol in urine, the urinary content of IFABP of 24 hours and endotoxin level of plasma were identified as the most intimate factors which could associate with gut barrier function. The optimal operating point of plasma endotoxin, ratio of urinary lactulose and mannitol and content of urinary IFABP of 24 hours were 0. 145, 17 ng and 0. 055 EU/ml respectively based on the results of receiver operating characteristic curve, the sensitivity and specificity were 84.5 % vs 88%, 78 % vs 88% and 78% vs 78%. The doubtable value interval of urinary ratio of lactulose and mannitol was limited as 0. 178 to 0. 082. Conclusion Gut barrier dysfunction should be suspected when critically ill patients presented certains gastrointestinal symptoms and had the proofs of increasing intestinal permeability, hypoperfusion of gut and higher level of plasma endotoxin.

关 键 词：肠屏障功能 障碍 影响因素 

分 类 号：R574[医药卫生—消化系统]