瓜氨酸和肠型脂肪酸结合蛋白对重症患者急诊胃肠损伤的诊断价值：一项530例患者的前瞻性研究  

Diagnostic value of citrulline and intestinal fatty acid binding protein on acute gastrointestinal injury in critical patients： a prospective study of 530 patients

作　　者：王静[1] 于丽梅[2] 夏永宏[1] 高艳玲[1] 于文波 孙海宏[1] 孙艺铸[1] 

机构地区：[1]烟台毓璜顶医院重症医学科,山东烟台264000 [2]烟台毓璜顶医院检验科,山东烟台264000

出　　处：《中华危重病急救医学》2017年第11期999-1003,共5页Chinese Critical Care Medicine

基　　金：山东省烟台市科技发展计划项目（2014WS022）

摘　　要：目的 观察重症医学科（ICU）患者急性胃肠损伤（AGI）的发生情况,探讨血清瓜氨酸、肠型脂肪酸结合蛋白（IFABP）对重症患者AGI的诊断价值.方法 采用前瞻性研究方法,选择2016年2月至2017年2月烟台毓璜顶医院ICU收治的576例重症患者,根据2012年欧洲危重病医学会（ESICM）提出的AGI诊断标准,观察患者AGI的发生情况并进行AGI分级,记录不同AGI分级患者的一般资料、病情严重程度及预后.按随机数字表法选择肾功能正常的AGIⅠ-Ⅳ级患者各20例,采集患者入ICU 12 h内股动脉血,采用高效液相色谱法（HPLC）检测血清瓜氨酸水平,采用酶联免疫吸附试验（ELISA）测定血清IFABP水平;以20例健康体检者作为健康对照组.绘制受试者工作特征曲线（ROC）,评价瓜氨酸和IFABP对AGI的诊断价值.结果 ① 576例重症患者均纳入最终分析,其中AGI患者530例（占92.0%）; 530例AGI患者中Ⅰ级289例（占54.5%）,Ⅱ级154例（占29.1%）,Ⅲ级64例（占12.1%）,Ⅳ级23例（占4.3%）.随AGI分级升高,患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）、ICU住院时间及28 d病死率均逐渐升高.② 与健康对照组比较,不同AGI分级各组患者血清瓜氨酸水平均明显降低,IFABP水平均明显升高;随着AGI分级升高,瓜氨酸水平逐渐降低,IFABP水平逐渐升高〔AGI Ⅰ、Ⅱ、Ⅲ、Ⅳ级组瓜氨酸（μmol/L）分别为14.1±3.6、12.7±3.1、8.3±2.7、5.6±3.4,F=3.287,P=0.027, IFABP（ng/L）分别为526.7±204.9、698.4±273.8、894.7±455.9、1062.8±532.2,F=2.903,P=0.043〕.ROC曲线分析显示,瓜氨酸对AGI的诊断价值较高,ROC曲线下面积（AUC）为0.927,当最佳截断值为9.7 μmol/L时,敏感度为87.5%,特异度为87.5%;而IFABP的AUC较低,为0.043,提示对AGI不具有诊断价值.结论 ICU重症患者AGI发生率较高,且AGI分级越高,病情越严重,预后越差.瓜氨酸对危重症患者AGI有较高的Objective To observe the incidence of acute gastrointestinal injury （AGI） in intensive care unit （ICU） patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein （IFABP） on diagnosis of AGI in critical patients. Methods A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine （ESICM） in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI Ⅰ to Ⅳ were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography （HPLC）. Serum IFABP level was determined by enzyme-linked immunosorbent assay （ELISA）. Twenty healthy subjects were selected as controls. The receiver operating characteristic curve （ROC） was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. Results ① 576 patients were enrolled in the analysis. Of which 530 patients （92.0%） had AGI, and 289 patients with gradeⅠ （54.5%）, 154 with grade Ⅱ （29.1%）,64 with grade Ⅲ （12.1%）, and 23 with grade Ⅳ （4.3%）. With the increase in AGI classification, acute physiology and chronic health evaluation system Ⅱ （APACHE Ⅱ） score, sequential organ failure score （SOFA）, the length of ICU stay and 28-day mortality were gradually increased. ② Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels �

关 键 词：胃肠损伤 急性 瓜氨酸 肠型脂肪酸结合蛋白 

分 类 号：R459.7[医药卫生—急诊医学]