肠脂肪酸结合蛋白与内毒素早期诊断肠屏障功能障碍的临床研究  

Clinical study on intestinal fatty acid binding protein and the endotoxin in early diagnosis of intestinalbarrier dysfunction

作　　者：孔令尚[1] 郭园园[3] 刘牧林[1] 何先弟 姜从桥[1] 刘瑞林[1] 

机构地区：[1]蚌埠医学院第一附属医院胃肠外科,安徽省233000 [2]重症医学科 [3]蚌埠医学院第二附属医院泌尿外科

出　　处：《中华消化杂志》2013年第4期240-243,共4页Chinese Journal of Digestion

基　　金：安徽省卫生厅科研资助项目（200813009）

摘　　要：目的筛选诊断肠屏障功能障碍特异度和敏感度较高的监测指标。方法收集存在肠屏障功能障碍且急性生理学及慢性健康状况（APACHE）Ⅱ评分≥8分的危重症患者70例及同期无肠屏障功能障碍且APACHEII评分≤6分的患者41例。记录患者一般情况、病史、症状、体征、24h尿量、机械通气治疗情况。留取静脉血，部分用于细菌培养，部分用于测定白细胞计数、肌酐水平、二胺氧化酶（DAO）活性、D-乳酸水平、肠脂肪酸结合蛋白（IFABP）水平、内毒素水平。留取尿液，测定尿IFABP水平。留取24h尿液，测定24h尿IFABP总量。对可能的肠屏障功能障碍影响因素进行单因素分析（计量资料行t检验，计数资料行X^2检验）和多因素分析，并以ROC曲线评价筛选出的影响因素。结果与肠屏障功能障碍相关的因素为白细胞计数（OR=3．971，P=0．046）、血内毒素水平（OR=7．857，P=0．005）、24h尿IFABP总量（OR=11．154，P=0．001）。以血内毒素水平和24h尿IFABP总量来推测肠屏障功能障碍的ROC曲线下面积值分别为0．852和0．820（P均〈0．01），其最佳临界值分别为8．0pg／ml和17．12ng，其敏感度分别为97．8％和84．4％，其特异度分别为66．7％和72．7％。结论危重症患者出现消化道症状和体征，同时有血内毒素水平增高（〉8．0pg／m1）和（或）24h尿IFABP总量〉17．12ng，提示可能发生肠屏障功能障碍。Objective To screen the high specific and sensitive monitoring indications in the diagnosis of intestinal barrier dysfunction. Methods A total of 70 critical patients with intestinal barrier dysfunction and acute physiology and chronic health evaluation （APACHE） Ⅱ score≥8 and over the same period 41 patients without intestinal barrier dysfunction and APACHE Ⅱ score≤6 were recruited. The general information, histories, symptoms, physical signs, 24 hours urine output and the condition of mechanical ventilation treatment were recorded. The venous blood was taken for bacteria culture, white blood cell counting, creatinine level, diamine oxidase （DAO） activity, D-lactic acid, intestinal fatty acid binding protein （IFABP） and endotoxin level testing. The urine was taken for urinary IFABP level testing. Twenty-four hours urine was reserved for 24 hours total urinary IFABP testing. The factors which might influence intestinal barrier dysfunction were analyzed by univariate analysis and multivariate analysis. The measurement data were analyzed by t test and thecount data were analyzed by X^2 test. The factors were screened according to receiver operating characteristic （ROC） curve. Results The factors related with intestinal barrier dysfunction were white blood cell counting （OR=3. 971 ,P=0. 046）, plasma endotoxin level （OR=7. 857,P=0. 005） and 24 hours total urinary IFABP （OR = 11. 154, P = 0.001）. The areas under the ROC curve （AUC） of plasma endotoxin level and 24 hours total urinary IFABP were 0. 852 and 0. 820 respectively （both P〈0.01）. The critical value was 8.0 pg/ml and 17.12 ng respectively. The sensitivity was 97.8% and 84.4%. The specificity was 66. 7% and 72. 7%. Conclusion Once critical patients presented certain gastrointestinal symptoms and physical signs with plasma endotoxin level 〉8.0 pg/ml and or 24 hours total urinary IFABP 〉17.12 ng, which might indicate intestinal barrier dysfunction.

关 键 词：肠 脂肪酸结合蛋白质类 内毒素类 尿分析 

分 类 号：R57[医药卫生—消化系统] R45[医药卫生—内科学]