血清肠型脂肪酸结合蛋白与胆碱酯酶联合检测在危重患者脓毒症诊断和预后中的价值  

Value of serum intestinal fatty acid binding protein combined with cholinesterase in diagnosis and prognosis of sepsis in critically ill patients

作　　者：童武进 顾魏峰 徐俊 胡立志 TONG Wujin;GU Weifeng;XU Jun;HU Lizhi(Department of Emergency,Qingpu Branch of Zhongshan Hospital,Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院急诊科,上海201700

出　　处：《中国急救复苏与灾害医学杂志》2024年第7期887-891,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市医学重点专科建设计划(编号:ZK2019807)。

摘　　要：目的 探讨血清肠型脂肪酸结合蛋白(I-FABP)与胆碱酯酶(ChE)联合检测在危重患者脓毒症诊断和预后中的价值。方法 选取2018年10月—2022年6月医院重症监护病房收治的258例危重患者作为研究对象,其中115例患者合并脓毒症纳入脓毒症组,143例无脓毒症纳入非脓毒症组。采用酶联免疫吸附试验测定患者ICU入院时的血清I-FABP和ChE水平,记录脓毒症患者院内病死率。结果 脓毒症组患者血清I-FABP水平显著高于非脓毒症组,血清ChE显著低于非脓毒症组(P<0.001)。血清I-FABP和ChE联合诊断危重患者脓毒症的受试者工作特征曲线下面积(AUC)为0.933(95%CI:0.903~0.962),灵敏度可达到90.4%,特异度可达到85.3%。血清I-FABP与SOFA评分呈正相关(r=0.269,P=0.004),ChE与SOFA评分呈负相关(r=-0.257,P=0.006)。死亡患者血清I-FABP水平明显高于存活患者,ChE明显低于存活患者(P<0.001)。急性生理学和慢性健康评估Ⅱ(APACHEⅡ)评分、血清I-FABP和ChE水平是脓毒症患者院内死亡的独立危险因素(P<0.05)。结论 血清I-FABP和ChE联合检测可良好识别危重患者脓毒症的发生以及院内死亡高风险的患者,有望成为危重患者脓毒症早期诊断和院内死亡预测的有效生物标志物。Objective To investigate the value of serum intestinal fatty acid binding protein(I-FABP) combined with cholinesterase(ChE) in the diagnosis and prognosis of sepsis in critically ill patients.Methods A total of 258 critically ill patients admitted to the intensive care unit of the hospital from October 2018 to June 2022 were selected as the research objects,of which 115 patients with sepsis were included in the sepsis group and 143 patients without sepsis were included in the non-sepsis group.Serum I-FABP and ChE levels of patients admitted to ICU were measured by enzyme-linked immunosorbent assay,and in-hospital mortality of patients with sepsis was recorded.Results Serum IFABP level in the sepsis group was significantly higher than that in the non-sepsis group.While serum ChE level was significantly lower than that in the non-sepsis group(P<0.001).The area under receiver operating characteristic curve(AUC) of serum I-FABP and ChE in the diagnosis of sepsis in critically ill patients was 0.933(95%CI:0.903-0.962),with a sensitivity of 90.4% and a specificity was 85.3%.Serum I-FABP level was positively correlated with SOFA score( r = 0.269,P = 0.004),and ChE was negatively correlated with SOFA score( r =-0.257,P = 0.006).The serum I-FABP levels of deceased patients were significantly higher than those of surviving patients,while ChE was significantly lower than those of surviving patients(P<0.001).Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores,serum I-FABP and ChE levels were independent risk factors for in-hospital mortality in sepsis patients(P<0.05).Conclusion The combined detection of serum I-FABP and ChE can well identify the occurrence of sepsis in critically ill patients and patients with a high risk of mortality.These biomarkers hold promise as useful indicators for early diagnosis of sepsis and the prediction of in-hospital mortality in critically ill patients.

关 键 词：肠型脂肪酸结合蛋白 胆碱酯酶 脓毒症 诊断 预后 

分 类 号：R631.2[医药卫生—外科学]