胃肠道功能障碍在肝硬化脓毒症患者预后中的价值  

Gastrointestinal dysfunction in prognosis of liver cirrhotic patients with sepsis

作　　者：韩才均 黄媛[2] 吴政燮 金星[3] 朴美花[1] 金花[4] HAN Cai-jun;HUANG Yuan;WU Zheng-xie;JIN Xing;PIAO Mei-hua;JIN Hua(Department of Laboratory Medicine,Yanbian University Hospital,Yanji 133000,China;Department of Gastroenterology,Yanbian University Hospital,Yanji 133000,China;Department of Infection,Yanbian University Hospital,Yanji 133000,China;Operating Room,Yanbian University Hospital,Yanji 133000,China)

机构地区：[1]延边大学附属医院检验科,吉林延吉133000 [2]延边大学附属医院消化内科,吉林延吉133000 [3]延边大学附属医院感染科,吉林延吉133000 [4]延边大学附属医院手术室,吉林延吉133000

出　　处：《中国感染控制杂志》2024年第2期162-168,共7页Chinese Journal of Infection Control

基　　金：延边大学应用基础项目(YDKJ202327)。

摘　　要：目的 评估急性胃肠道损伤(AGI)和肠脂肪酸结合蛋白(I-FABP)在肝硬化脓毒症患者预后中的价值。方法 回顾性分析2020年9月—2023年3月某院重症监护病房(ICU)收治的84例肝硬化脓毒症患者临床资料,并选择同期41例失代偿期肝硬化患者作为对照组。采用酶联免疫吸附测定(ELISA)法测定患者血清I-FABP水平。计算入院终末期肝病模型(MELD)和序贯器官衰竭评估(SOFA)评分,根据住院病历评估AGI程度,观察30天和90天生存状况。采用Spearman相关分析判断变量间相关性,多因素Cox回归分析确定肝硬化脓毒症死亡的危险因素。采用受试者工作特征(ROC)曲线确定最佳临界值,ROC曲线下面积(AUC)比较诊断效能。结果 肝硬化脓毒症组患者AGI分级和I-FABP水平均高于对照组(均P<0.05)。肝硬化脓毒症患者I-FABP与降钙素原(PCT)、MELD和SOFA评分均相关(均P<0.05),AGI分级与SOFA评分呈正相关(P=0.038)。肝硬化脓毒症组患者30天病死率为25.0%(21例),90天病死率为35.7%(30例)。多因素Cox回归分析显示,基线I-FABP、SOFA评分与30天和90天生存结局独立相关,且I-FABP四分位数显示出良好的预后区分能力。ROC曲线显示,I-FABP能明显提高SOFA评分对患者预后的预测效能。结论 肝硬化脓毒症患者AGI分级和I-FABP水平明显升高。血清I-FABP与患者预后相关,并可提高SOFA评分对生存结局的预测效能。Objective To assess the value of acute gastrointestinal injury(AGI)and intestinal fatty acid-binding protein(I-FABP)in the prognosis of liver cirrhotic patients with sepsis.Methods Clinical data of 84 liver cirrhosis patients with sepsis who were admitted to the intensive care unit(ICU)of a hospital from September 2020 to March 2023 were analyzed retrospectively,and 41 patients with decompensated liver cirrhosis during the same period were selected as the control group.Serum I-FABP level in patients was determined with enzyme-linked immunosorbent assay(ELISA).Scores of the model of end-stage liver disease(MELD)and sequential organ failure assessment(SOFA)were calculated.AGI was evaluated based on medical records.30-day and 90-day survival was observed.Correlation among variables was analyzed by Spearman correlation.Risk factors for death in patients with liver cirrhosis and sepsis was determined by multivariate Cox regression analysis.The optimal cut-off value was determined by receiver operating characteristic(ROC)curve,and the diagnostic efficacy was compared through the area under the ROC curve(AUC).Results Both AGI grading and I-FABP level in liver cirrhosis patients with sepsis were higher than those in the control group(both P<0.05).I-FABP level was correlated with procalcitonin(PCT),MELD,and SOFA scores in patients with liver cirrhosis and sepsis(all P<0.05).AGI grading was positively correlated with SOFA score(P=0.038).The 30-day and 90-day mortality of patients in the liver cirrhosis with sepsis group were 25.0%(n=21)and 35.7%(n=30),respectively.Multivariate Cox regression analysis showed that baseline I-FABP and SOFA scores were independently correlated with 30-day and 90-day survival,and the I-FABP quartile showed good prognostic differentiation efficacy.ROC curve showed that I-FABP could significantly improve the predictive effect of SOFA score on the prognosis of patients.Conclusion AGI grading and I-FABP level in liver cirrhosis patients with sepsis are elevated significantly.Serum I-FABP is associa

关 键 词：肝硬化 脓毒症 胃肠道功能障碍 肠脂肪酸结合蛋白 急性胃肠道损伤 

分 类 号：R575.2[医药卫生—消化系统] R515.3[医药卫生—内科学]