D-乳酸和I-FABP对ICU患者病情严重程度及预后的评估价值  

Clinical study of D-lactate and intestinal fatty acid binding protein in evaluating disease severity and prognosis of ICU patients:secondary analysis of a prospective,multicenter clinical study

作　　者：邱春芳[1] 王陆豪 陈传希[1] 管向东[1] 欧阳彬[1] Qiu Chunfang;Wang Luhao;Chen Chuanxi;Guan Xiangdong;Ouyang Bin(Department of Intensive Care Unit,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China)

机构地区：[1]中山大学附属第一医院重症医学科,广东广州510080

出　　处：《中华危重病急救医学》2020年第11期1331-1335,共5页Chinese Critical Care Medicine

摘　　要：目的分析血清D-乳酸和肠脂肪酸结合蛋白(I-FABP)与重症监护病房(ICU)患者病情严重程度及预后的关系。方法采用回顾性研究方法,对本课题组前期发表的一项评估经脂肪改良的肠内营养(EN)混悬液对ICU患者肠道屏障影响的前瞻性、单盲、多中心随机临床研究结果中的数据进行二次分析。此项研究在华南地区7家三级甲等医院ICU共招募141例患者;另纳入15例健康志愿者作为健康对照组。收集该研究中患者的临床资料,包括性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、C-反应蛋白(CRP)和初次入住ICU诊断等疾病严重程度相关指标和ICU住院时间、总住院时间以及患者28 d预后等相关指标。比较ICU患者在入院第0天(EN混悬液使用达到500 mL前1 d)和第5天(EN混悬液每日使用≥2092 kJ,持续5 d)血清D-乳酸、I-FABP含量与健康对照组的差异。将患者按血流动力学和(或)机械通气等指标在第5天(与第0天相比)的状况,分为病情改善组(101例)和病情未改善组(40例),观察病情是否改善两组患者D-乳酸和I-FABP的变化。采用Spearman相关分析法分析血清D-乳酸、I-FABP与病情严重程度的相关性,以及D-乳酸、I-FABP的动态变化对ICU患者28 d预后的预测价值。结果与健康对照组相比,ICU患者第0天血清D-乳酸和I-FABP水平均明显升高〔D-乳酸(mg/L):10.82(3.31,25.48)比6.63(1.54,17.70),I-FABP(ng/L):519.60(159.06,1362.14)比84.40(30.78,108.57),均P<0.01〕,第5天D-乳酸和I-FABP均较第0天明显降低,但仍高于健康对照组。第0天病情改善组I-FABP较病情未改善组明显降低,两组D-乳酸水平比较差异无统计学意义;第5天时两组D-乳酸和I-FABP均较第0天时明显降低,且第5天病情改善组D-乳酸和I-FABP均明显低于病情未改善组〔D-乳酸(mg/L):7.61(1.71,27.22)比9.38(2.09,20.56),I-FABP(ng/L):378.65(152.56,864.62)比521.21(205.93,1413.11),均P<0.05〕Objective To analyze the relationship between D-lactate,intestinal fatty acid binding protein(I-FABP)and the severity as well as the prognosis of patients in intensive care unit(ICU).Methods Using a retrospective approach,the data derived from a prospective,randomized,single-blind,multicenter clinical study published earlier by our group were further analyzed to evaluate the effect of fat-modified enteral nutrition(EN)suspension on the intestinal barrier in ICU patients.In this study,a total of 141 patients were recruited from 7 ICUs in South China,and 15 healthy volunteers were included as healthy control group.Clinical data of patients were collected,including gender,age,disease severity related indicators such as acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),C-reactive protein(CRP)and initial ICU diagnosis,as well as prognostic indicators such as length of stay in ICU,length of stay in hospital and prognosis of patients at 28 days.To compare the difference of serum D-lactate and I-FABP between ICU patients and healthy control group on day 0(the day before EN reached 500 mL)and day 5(EN≥2092 kJ/d for 5 days).According to the hemodynamic and/or mechanical ventilation status on day 5(compared with day 0),141 patients were divided into the improvement group(101 cases)and the non-improvement group(40 cases),and the changes of D-lactate and I-FABP in the two groups were observed.Spearman correlation analysis was used to analyze the correlation between serum D-lactate,I-FABP and the severity of the disease,as well as the predictive value of dynamic changes of D-lactate and I-FABP on the prognosis of 28 days.Results Compared with the healthy volunteers,the serum D-lactate and I-FABP levels of ICU patients on day 0 were significantly increased[D-lactate(mg/L):10.82(3.31,25.48)vs.6.63(1.54,17.70),I-FABP(ng/L):519.60(159.06,1362.14)vs.84.40(30.78,108.57),both P<0.01],and D-lactate and I-FABP on day 5 were both decreased compared with the levels on day 0,but still

关 键 词：肠屏障损伤 D-乳酸 肠脂肪酸结合蛋白 重症患者 

分 类 号：R459.7[医药卫生—急诊医学] R459.3[医药卫生—治疗学]