脓毒症预后不良患者血清I-FABP、DAO、D-Lac水平变化及其危险因素探讨  

Changes of serum I-FABP,DAO and D-Lac levels in patients with poor prognosis of sepsis and their risk factors

作　　者：孟蕾[1] 宋维鹏[1] 刘秀娟[1] 赵丽坤[1] 王萌 邱方[1] 檀森 国强华[1,2] 左志刚[1] MENG Lei;SONG Weipeng;LIU Xiujuan;ZHAO Likun;WANG Meng;QIU Fang;TAN Sen;GUO Qianghua;ZUO Zhigang(Department of Critical Care Medicine,Qinhuangdao,the First Hospital,Qinhuangdao,Hebei,China,066001;Department of Cardiology,Qinhuangdao,the First Hospital,Qinhuangdao,Hebei,China,066001;Department of Proctology,Qinhuangdao Hospital of Traditional Chinese Medicine,Qinhuangdao,Hebei,China,066001)

机构地区：[1]秦皇岛市第一医院重症医学一科,河北秦皇岛066001 [2]秦皇岛市第一医院心内科,河北秦皇岛066001 [3]秦皇岛市中医医院肛肠科,河北秦皇岛066001

出　　处：《分子诊断与治疗杂志》2023年第2期265-268,272,共5页Journal of Molecular Diagnostics and Therapy

基　　金：秦皇岛市科学技术研究与发展计划(201902A068)。

摘　　要：目的 探讨脓毒症预后不良患者血清肠型脂肪酸结合蛋白(I-FABP)、二胺氧化酶(DAO)、D-乳酸(D-Lac)水平变化及其危险因素。方法 收集2017年7月至2020年3月秦皇岛市第一医院收治的454例脓毒症患者临床资料,根据患者预后情况将其分为预后良好组(273例)和预后不良组(181例),统计脓毒症患者预后不良发生现状及其单因素,采用多因素Logistic回归分析脓毒症患者预后不良的危险因素。结果 454例脓毒症患者预后不良共181例,预后不良发生率为39.87%。单因素分析结果显示,预后不良组与预后良好组年龄、平均动脉压(MAP)、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分、感染相关器官功能衰竭(SOFA)评分、外周血白细胞(WBC)、中性粒细胞(NEU)、血清C反应蛋白(CRP)、降钙素原(PCT)、尿素氮(BUN)、血肌酐(Scr)、总胆红素(TBil)、前白蛋白(PAB)、I-FABP、DAO、D-Lac、D-二聚体(D-d)水平及凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄较大、MAP较低、APACHEⅡ评分较高、SOFA评分较高、外周血NEU、血清CRP、PCT、BUN、Scr、DAO、D-Lac、D-d、I-FABP水平较高、PT、APTT较长均为脓毒症患者预后不良的独立危险因素(P<0.05)。结论 脓毒症患者预后不良发生率较高,同时其危险因素与患者年龄、MAP、APACHEⅡ、SOFA评分、外周血NEU、血清CRP、PCT、BUN、Scr、DAO、D-Lac、D-d、I-FABP水平、PT、APT有关。Objective To investigate the changes of serum levels of intestinal fatty acid binding protein(I-FABP),diamine oxidase(DAO)and D-lactic acid(D-Lac)in patients with poor prognosis of sepsis and their risk factors. Methods The clinical data of 454 sepsis patients admitted to the First Hospital of Qinhuangdao City from July 2017 to March 2020 were collected. According to the prognosis of patients,they were divided into the good prognosis group(273 cases) and the poor prognosis group(181 cases). The incidence of poor prognosis in patients with sepsis and its single factors were analyzed. Multi-factor Logistic regression was used to analyze the risk factors for poor prognosis in patients with sepsis. Results 181 of 454 patients with sepsis had poor prognosis,and the incidence of poor prognosis was 39.87%. The result of single factor analysis showed that,the poor prognosis group and the good prognosis group differed in age,mean arterial pressure(MAP),score of acute physiological and chronic health status score Ⅱ(APACHEⅡ),score of infection-related organ failure(SOFA),levels of peripheral blood leukocytes(WBC),neutrophils(NEU),serum levels of C-reactive protein(CRP),procalcitonin(PCT),urea nitrogen(BUN),blood creatinine(Scr),total bilirubin(TBil),prealbumin(PAB),I-FABP,DAO,D-Lac,and D-dimer(D-d),prothrombin time(PT),activated partial prothrombin time(APTT),and international normalized ratio(INR)(P<0.05).The result of multivariate Logistic regression analysis showed that older age,lower MAP,higher scores of APACHE II and SOFA,higher levels of peripheral blood NEU and serum CRP,PCT,BUN,Scr,DAO,D-Lac,D-d,I-FABP,longer PT and APTT were all the independent risk factors for poor prognosis of patients with sepsis(P<0.05). Conclusion The incidence of poor prognosis in patients with sepsis is high,and its risk factors are related to patient age,MAP,scores of APACHE Ⅱ,SOFA score,peripheral blood NEU,serum CRP,PCT,BUN,Scr,DAO,D-Lac,D-d,I-FABP levels,PT and APTT.

关 键 词：脓毒症 预后不良 肠型脂肪酸结合蛋白 二胺氧化酶 D-乳酸 

分 类 号：R459.7[医药卫生—急诊医学]