肠脂肪酸结合蛋白在脑外伤合并胃肠功能损伤患儿血清中的变化及意义  

Changes and significance of serum intestinal fatty acid binding protein in children with traumatic brain injury complicated with gastrointestinal dysfunction

作　　者：葛唱 王怀立[1] 范晓蕾[1] 陈晓昕[1] 李海英[1] Ge Chang;Wang Huaili;Fan Xiaolei;Chen Xiaoxin;Li Haiying(Department of Pediatric Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院PICU,450052

出　　处：《中国小儿急救医学》2019年第2期113-117,共5页Chinese Pediatric Emergency Medicine

基　　金：二〇一六年度河南省医学科技攻关计划项目(201602020)。

摘　　要：目的探讨创伤性颅脑外伤合并急性胃肠功能损伤(acute gastrointestinal injury,AGI)患儿血清中肠脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)的变化及临床意义。方法选择2017年1月至2018年3月于郑州大学第一附属医院PICU住院的颅脑外伤患儿95例,根据改良Glasgow昏迷评分法,且结合急性闭合性颅脑损伤临床分型标准将患儿按颅脑损伤程度分组(轻度43例,中度23例,重度29例),并进行AGI分级(AGIⅠ级42例,AGIⅡ级30例,AGIⅢ级13例,AGIⅣ级10例)。同时期我院门诊健康体检儿童30例为健康对照组。留取患儿入院时及入院第3天外周血标本,采用酶联免疫吸附法检测血清IFABP。比较各组间及组内不同时间点血清IFABP浓度的差异;对血清IFABP水平与颅脑损伤程度和AGI分级进行相关性分析;绘制受试者工作特征(ROC)曲线,评价IFABP对颅脑外伤患儿合并AGI的诊断价值。结果颅脑损伤各组患儿入院当天血清IFABP水平均高于健康对照组(均P<0.01),且随颅脑损伤程度加重,血清IFABP水平增高,差异有统计学意义(均P<0.01)。AGIⅠ~Ⅳ级组入院当天血清IFABP水平均高于健康对照组(均P<0.01),且随AGI分级增高,血清IFABP水平增高,差异有统计学意义(均P<0.01)。入院当天血清IFABP浓度分别与颅脑损伤程度和AGI分级呈正相关(rs=0.82,P<0.01;rs=0.70,P<0.01)。入院治疗第3天,各组血清IFABP水平较入院时均下降,差异有统计学意义(均P<0.01)。ROC曲线分析示血清IFABP对颅脑外伤合并AGI患儿的诊断价值较高,ROC曲线下面积为0.88,当最佳截断值为431.36ng/L时,敏感度为71.61%,特异度为90.00%。结论血清IFABP可以作为颅脑损伤患儿合并胃肠损伤早期诊断和病情评估的敏感指标。Objective To study the changes and significance of serum intestinal fatty acid binding protein(IFABP)in children with traumatic brain injury(TBI)complicaled with acute gastrointestinal injury(AGI).Methods A total of 95 children suffering from TBI hospitalized in the PICU of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2018 were enrolled in the study.According to the modified Glasgow coma score combined with clinical classification criteria for acute closed head injury,the cases were devided into mild(43 cases),moderate(23 cases),and severe(29 cases).Children were graded according to AGI(AGI Ⅰ42 cases,AGI Ⅱ 30 cases,AGI Ⅲ 13 cases,and AGI Ⅳ 10 cases).Thirty healthy children who underwent physical examination at outpatient service were enrolled as the control group.Blood samples were collected at the time of admission and on the 3rd day after admission.Serum IFABP was detected by ELISA,and the differences of serum IFABP concentrations were compared among groups.The correlations between IFABP with TBI classification and AGI grade were analyzed.The receiver operating characteristic(ROC)curve was drawn,and the predictive values of IFABP for the diagnosis of children with TBI complicated with AGI were evaluated.Results On the day of admission,the serum levels of IFABP in mild,moderate and severe brain injury group were significantly higher than that in control group(all P<0.01).And serum IFABP concentration gradually increased with the increase of brain injury(all P<0.01).Serum IFABP levels in children with AGI grade Ⅰto Ⅳ were significantly higher than those in control group(all P<0.01).The levels of serum IFABP also increased with the increase of AGI level(all P<0.01).The concentration of serum IFABP was positively correlated with the grade of TBI and AGI(rs=0.82,P<0.01;rs=0.70,P<0.01).In each group,the levels of serum IFABP on the 3rd day after admission were lower than those on admission(all P<0.01).The ROC curve analysis showed that serum IFABP was of high diagnostic

关 键 词：肠脂肪酸结合蛋白 颅脑外伤 胃肠功能损伤 儿童 

分 类 号：R726.5[医药卫生—儿科]