危重症患儿胃肠功能衰竭诊断指标价值的探讨  

The value of diagnosing gastrointestinal dysfunction in critically ill children with criteria

作　　者：张妮[1] 王凡[1] 徐晓楠[1] 朱保权[1] 张庆立[1] 刘关键[2] 

机构地区：[1]兰州大学第二医院儿科,730030 [2]华西医科大学中国循证中心

出　　处：《中国医师进修杂志》2010年第6期7-8,共2页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨危重症患儿胃肠功能衰竭不同实验室诊断指标的价值。方法76例危重症患儿，合并胃肠功能衰竭48例，测定其血浆D哥L酸、血清及尿液肠型脂肪酸结合蛋白（IFABP）浓度，筛选出对胃肠功能衰竭诊断有价值的指标，计算其灵敏度、特异度及ROC曲线下面积，比较其诊断价值。结果血浆D-乳酸浓度≥9．63mg／L，诊断危重症胃肠功能衰竭的灵敏度为85．2％，特异度为70．9％，ROC曲线下面积为0．822；血清IFABP浓度≥0．129μg／L，诊断危重症胃肠功能衰竭的灵敏度为65．2％，特异度为63．8％，ROC曲线下面积为0．744；尿液IFABP浓度≥0．330μg／L，诊断危重症胃肠功能衰竭的灵敏度为78．3％，特异度为72．3％，ROC曲线下面积为0．820。血清及尿液IFABP浓度ROC曲线下面积比较差异无统计学意义（P〉0．05）；血浆D-乳酸浓度与血清IFABP浓度ROC曲线下面积比较差异无统计学意义（P〉0．05）。结论血浆D-乳酸、血清及尿液IFABP对危重症患儿胃肠功能衰竭有诊断价值，但血浆D-乳酸、尿液IFABP可能更适合于临床。Objective To discuss the value of diagnosing gastrointestinal dysfunction in critically ill children. Methods Seventy-six critically ill patients were reviewed, 48 cases combined with gastrointestinal dysfunction. Plasma D-lactate, intestinal fatty acid binding protein （IFABP） of serum and urine were performed in all patients, detected the sensitivity and specificity, calculated the area under the ROC curve （AUC）. Results Plasma D-lactate level ≥ 9.63 mg/L had a sensitivity of 85.2%, specificity of 70.9%, and AUC of 0.822 for diagnosing gastrointestinal dysfunction. Serum IFABP level≥ 0. 129μg/L had a sensitivity of 65.2%, specificity of 63.8%, and AUC of 0.744 for diagnosing gastrointestinal dysfunction. Urine IFABP ≥0.330μg/L had a sensitivity of78.3%, specificity of 72.3%, and AUC of 0.820 for diagnosing gastrointestinal dysfunction. There was no significant difference in AUC between plasma and urine IFABP （P 〉 0.05 ）, there was no significant difference in AUC between serum D-lactate and serum IFABP （P 〉 0.05 ）. Conclusions Plasma D-lactate, serum and urine IFABP may be useful markers as warning gastrointestinal dysfunction of critically ill children. Plasma D-lactate and urine IFABP level may be more sensitively, but they need to be further studied.

关 键 词：危重病 胃肠功能衰竭 D-乳酸 肠型脂肪酸结合蛋白 

分 类 号：R459.7[医药卫生—急诊医学]