肠脂肪酸结合蛋白与严重脓毒症患者肠道损伤的相关性研究  

Correlation of intestinal fatty acid binding protein and intestinal injury in severe sepsis

作　　者：朱承睿[1] 丁仁彧[1] 孙旖旎[1] 马晓春[1] 

机构地区：[1]中国医科大学附属第一医院重症医学科,辽宁沈阳110001

出　　处：《中华危重病急救医学》2014年第6期420-424,共5页Chinese Critical Care Medicine

摘　　要：目的 探讨严重脓毒症患者血清肠脂肪酸结合蛋白（IFABP）浓度变化及临床意义.方法 采用前瞻性观察性研究方法,选择2012年7月至12月入住中国医科大学附属第一医院重症监护病房（ICU）严重脓毒症患者50例,同期选取本院健康体检者20例作为对照组,患者入ICU时及1d、3d采用酶联免疫吸附试验（ELISA）测定血清IFABP浓度及炎症因子白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）浓度,并计算患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及序贯器官衰竭评分（SOFA）,记录28 d生存情况,同时对患者进行急性胃肠损伤（AGI）分级.分别比较健康对照组与严重脓毒症组、腹腔感染组与非腹腔感染组、存活组与死亡组、不同AGI分级组间IFABP浓度的差异;并对IFABP与炎症因子、评分、ICU住院时间、机械通气时间进行相关性分析;对患者28d预后进行多因素logistic回归分析.结果 入ICU时及1d、3d,严重脓毒症患者血清IFABP浓度明显高于健康对照组（mg/L：731.90±53.91、592.07±41.94、511.85±47.97比439.88±23.68,均P=0.000）;腹腔感染组与非腹腔感染组、存活组与死亡组、不同AGI分级组间各时间点IFABP浓度差异均无统计学意义.相关分析显示,严重脓毒症患者IFABP与IL-6 （r=0.794,P=0.000）、TNF-α（r=0.878,P=0.010）、APACHEⅡ评分（r=0.428,P=0.000）均有显著相关性;腹腔感染组IFABP与IL-6（r=0.812,P=0.000）、TNF-α （r=0.885,P=0.000）及非腹腔感染组IFABP与IL-6（r=0.739,P=0.000）和TNF-α（r=0.828,P=0.000）相关性较好.多因素logistic回归分析显示,入ICU时及1d、3 d SOFA评分为严重脓毒症患者28 d死亡的独立危险因素,优势比（OR）分别为1.624（P=0.004）、1.411（P=0.027）、1.740（P=0.012）,而IFABP浓度、AGI分级、APACHEⅡ评分对患者预后无明显影响.结论 严重脓毒症患者血清IFABP浓度明显增高,与IL-6、TNF-α、APACHEⅡ评分存在较Objective To investigate the content of intestinal fatty acid binding protein （IFABP） and its clinical significance in patients with severe sepsis.Methods A prospective observational study was conducted.Fifty patients with severe sepsis admitted to intensive care unit （ICU） of the First Affiliated Hospital of China Medical University from July to December 2012 were enrolled,and 20 healthy patients served as control group.The concentrations of serum IFABP,interleukin-6 （IL-6）,and tumor necrosis factor-α （TNF-α） were determined with enzyme-linked immunosorbent assay （ELISA） on days 0,1 and 3 after ICU admission.Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） and sequential organ failure assessment （SOFA） score,28-day prognosis,acute gastrointestinal injury （AGI） grade were recorded at the same time.Furthermore,the contents of IFABP were compared between control group and the severe sepsis group,abdominal infection group and non-abdominal infection group,the survival group and the death group,as well as among different AGI-grade groups.Correlation analysis of IFABP and inflammatory factors,IFABP and two scores,and IFABP and time of stay in ICU and mechanical ventilation were studied.Multivariate logistic regression and analysis of 28-day outcome of the patients were also studied.Results IFABP levels were increased in severe sepsis patients on days 0,1 and 3 compared with those of healthy control group （mg/L：731.90 ±53.91,592.07 ±41.94,511.85 ±47.97 vs.439.88 ±23.68,all P =0.000）.There was no statistical significance of IFABP levels between abdominal infection group and non-abdominal infection group,the survival group and the death group,or among different AGI-grade groups.The correlation analysis showed that IFABP was statistically related with IL-6 （r=0.794,P=0.000）,TNF-α （r=0.878,P=0.010）,APACHE Ⅱ score （r=0.428,P=0.000） in patients with severe sepsis.Significant correlations were also found between IFABP and IL-6 （r=0.812,P=0.000）,TNF-

关 键 词：肠脂肪酸结合蛋白 严重脓毒症 急性胃肠功能损伤 

分 类 号：R459.7[医药卫生—急诊医学]