脓毒症患者肠道短链脂肪酸的变化及临床意义分析  

Changes and clinical significance of intestinal short-chain fatty acid in patients with sepsis

作　　者：范彬 张立 汪逸 胡秀平[1] 徐良[1] FAN Bin;ZHANG Li;WANG Yi;HU Xiuping;XU Liang(Emergency and Critical Care Center,Intensive Care Unit,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital of Hangzhou Medical College),Hangzhou 310014,Zhejiang,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)急诊重症中心重症医学科,浙江杭州310014

出　　处：《中国现代医生》2023年第27期19-22,共4页China Modern Doctor

基　　金：浙江省卫生健康科技计划项目(2021KY521)。

摘　　要：目的探讨脓毒症肠道短链脂肪酸(short-chain fatty acid,SCFA)的变化及临床意义。方法采用观察性研究方法,选择2019年1月至2022年6月浙江省人民医院ICU收治的脓毒症患者50例,根据28d后转归情况分为存活组和死亡组,记录入科时患者的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)和序贯器官衰竭评分(sequential organ failure assessment,SOFA),测定患者入科时超敏C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)及第1次粪便样品的乙酸、丙酸、丁酸含量,比较存活组和死亡组患者的APACHEⅡ、SOFA、CRP、PCT、乙酸、丙酸、丁酸的差异。结果死亡组患者的APACHEⅡ、SOFA、PCT均高于存活组,差异有统计学意义(P<0.05),CRP差异无统计学意义(P>0.05);死亡组患者的乙酸、丙酸、丁酸含量较存活组明显降低,差异有统计学意义(P<0.05)。Logistic回归分析提示,APACHEⅡ评分、乙酸、丙酸、丁酸是脓毒症患者28d死亡的独立危险因素(P<0.05)。结论脓毒症患者肠道的乙酸、丙酸、丁酸含量明显降低,提示肠道功能失衡,可作为评估预后的指标。Objective To investigate the changes of short-chain fatty acid(SCFA)in intestinal tract of sepsis and its clinical significance.Methods Fifty patients with sepsis that admitted to ICU of Zhejiang Provincial People’s Hospital from January 2019 to June 2022 were selected,and they were divided into survival group and death group according to the outcome after 28 days.Acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)were recorded at admission.The contents of hypersensitive C-reactive protein(CRP),procalcitonin(PCT)and acetic acid,propionic acid and butyric acid in the first fecal sample were determined.The differences of APACHEⅡ,SOFA,CRP,PCT,acetic acid,propionic acid and butyric acid between survival group and death group were compared.Results APACHEⅡ,SOFA and PCT in death group were higher than those in survival group,the difference was statistically significant(P<0.05),CRP was not statistically significant(P>0.05),and the contents of acetic acid,propionic acid and butyric acid in death group were significantly lower than those in survival group,the difference was statistically significant(P<0.05).Logistic regression analysis indicated that APACHEⅡscore,acetic acid,propionic acid and butyric acid were independent risk factors for sepsis death at 28 days(P<0.05).Conclusion The contents of acetic acid,propionic acid and butyric acid in the intestinal tract of sepsis patients were significantly reduced,suggesting that intestinal function was unbalanced and could be used as a prognostic indicator.

关 键 词：脓毒症 肠道 短链脂肪酸 

分 类 号：R574[医药卫生—消化系统]