急性胃肠损伤分级在危重病患者炎症反应中的意义  

Clinical significance of acute gastrointestinal injury grades in inflammatory response of critically ill patients

作　　者：王静[1] 高艳玲[1] 于文波 夏永宏[1] 孙艺铸[1] 

机构地区：[1]烟台毓璜顶医院重症医学科,山东省烟台264000

出　　处：《中华医学杂志》2017年第42期3312-3315,共4页National Medical Journal of China

基　　金：烟台市科技计划（2014WS022）

摘　　要：目的 探讨急性胃肠损伤（AGI）分级在危重患者炎症反应中的意义.方法 2014年7月至2015年6月烟台毓璜顶医院重症医学科（ICU）收治的重症患者中随机选取AGI严重程度Ⅰ、Ⅱ、Ⅲ、Ⅳ级的患者各20例.免疫荧光法检测外周血单个核细胞核因子（NF）-κB表达;酶联免疫吸附法测定血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6水平;并测量降钙素原（PCT）、C反应蛋白（CRP）;进行统计学分析.结果 AGIⅠ级和AGIⅡ级患者NF-κB p65主要位于细胞质,AGIⅢ级患者和AGIⅣ级患者NF-κB p65主要位于细胞核,表明炎症刺激诱导了NF-κB的核移位.随着AGI分级越高,TNF-α、IL-6分泌明显升高,AGI Ⅰ -Ⅳ级患者 TNF-α分别表达为（89.76 ±19.78）ng/L、（130.54 ±23.18）ng/L、（224.65 ±39.02）ng/L、（293.17 ±36.79）ng/L,各组差异有统计学意义（P〈0.05）;IL-6分别表达为（45.96 ±9.62）ng/L、（89.26 ±12.77）ng/L、（203.71 ±58.26）ng/L、（331.18 ± 64.28）ng/L,各组差异有统计学意义（P〈0.05）.随着AGI分级越高,PCT、CRP水平明显升高,AGIⅠ~Ⅳ级患者PCT水平分别为（2.65 ±1.78）μg/L、（3.92 ±2.14）μg/L、（9.92 ±3.89）μg/L、（27.34 ± 8.45）μg/L,各组差异有统计学意义（P〈0.05）;CRP 水平分别为（13.82 ±4.93）mg/L、（32.14 ± 8.97）mg/L、（93.49 ±25.72）mg/L、（183.05 ±51.36）mg/L,各组差异有统计学意义（P〈0.05）.结论 危重患者AGI分级和炎症指标有一定的相关性,表明胃肠道功能障碍可能是引发全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）的启动因子和刺激因子.为危重患者根据AGI分级判断炎症反应程度提供了临床依据.Objective To explore the value of acute gastrointestinal injury（AGI）grades in inflammatory response of critically ill patients.Methods Ptients with AGI severity from Ⅰ to Ⅳ were randomly selected（20 for each）from July 2014 to June 2015 in ICU of Yantai Yuhuangding Hospital.The expression of NF-κB were detected by immunofluorescence.The expression of TNF-αand IL-6 were detected by enzyme linked immunosorbent assay（ELISA）.Procalcitonin（PCT）and C reactive protein（CRP）were measured.Statistical analysis was carried out.Results For AGI grade Ⅰand AGI gradeⅡpatients,NF-κB p65 were located mainly in cytoplasm.For AGI grade Ⅲ and AGI grade Ⅳ patients, NF-κB p65 were mainly located in the nucleus,indicating that inflammatory stimulation induces nuclear translocation of NF-κB.With the higher grade of AGI, TNF-αand IL-6 secretion increased significantly.For AGI grade Ⅰ to grade Ⅳpatients, TNF-αwere expressed as（89.76 ±19.78）ng/L,（130.54 ±23.18）ng/L,（224.65 ± 39.02）ng/L,（293.17 ±36.79）ng/L,and the difference was statistically significant（P〈0.05） respectively.IL-6 were expressed as（45.96 ±9.62）ng/L,（89.26 ±12.77）ng/L,（203.71 ±58.26）ng/L, （331.18 ±64.28）ng/L,the difference was statistically significant（P〈0.05）.With the higher grade of AGI,PCT and CRP levels were significantly increased.For AGI grade Ⅰ to grade Ⅳ patients, PCT levels were（2.65 ±1.78）μg/L,（3.92 ±2.14）μg/L,（9.92 ±3.89）μg/L,（27.34 ±8.45）μg/L,and the difference was statistically significant（P〈0.05）.CRP levels were（13.82 ±4.93）mg/L,（32.14 ± 8.97）mg/L,（93.49 ±25.72）mg/L,（183.05 ±51.36）mg/L,and the difference between each group was statistically significant（P〈0.05）.Conclusions There is a certain correlation between AGI classification and inflammatory markers in critically ill patients,which shows that gastrointestinal dysfunction may be the promoter and stimulating factor in systemic inflammatory response syndrome（

关 键 词：急性胃肠损伤 炎症 NF—κB 多器官功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]