基于肠道生物标志物探讨三种营养策略对重度胃肠损伤患者的价值  

Gut biomarkers for evaluating the merits of three nutritional strategies in patients with severe gastrointestinal injury

作　　者：朱金伟 陆件[1] 宁文娜 陈亚欧 Zhu Jinwei;Lu Jian;Ning Wenna;Chen Yaou(Department of Critical Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital,Gusu College,Nanjing Medical University),Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院(南京医科大学姑苏学院,苏州市立医院本部)重症医学科,江苏苏州215000

出　　处：《中华危重症医学杂志（电子版）》2024年第2期111-117,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：苏州市卫生计生委科技项目(LCZX202112);南京医科大学姑苏学院科研项目(CSKY20210215)。

摘　　要：目的:通过肠道生物标志物肠型脂肪酸结合蛋白(I-FABP)、D-乳酸、瓜氨酸水平评价3种营养策略在重度胃肠损伤患者中的价值。方法:选择2021年2月至2023年1月南京医科大学附属苏州医院重症监护室收治的117例重度胃肠损伤患者,采用随机数字表法将所有入选患者分为标准喂养组(38例)、滋养性肠内营养(EN)+肠外营养(PN)组(40例)和全肠外营养(TPN)组(39例)。早期肠内营养统一于入院后24 h开始。比较3组患者的基线资料、不同时间点I-FABP、D-乳酸、瓜氨酸及胃肠道耐受性、28 d生存率以及标准喂养组与滋养性EN+PN组喂养中断发生率。记录标准喂养组与滋养性EN+PN组肠内喂养持续时间,绘制Kaplan-Meier生存曲线。结果:3组患者EN开始前、入院第3天和入院第7天肠道生物标志物I-FABP、D-乳酸及瓜氨酸水平比较,差异均有统计学意义(F=2.772、2.797、7.902,P=0.028、0.027、<0.001)。进一步两两比较发现,入院第3天滋养性EN+PN组患者I-FABP、D-乳酸水平均较标准喂养组显著降低,而TPN组I-FABP水平较滋养性EN+PN组显著升高;入院第7天滋养性EN+PN组患者瓜氨酸水平较标准喂养组显著升高,而TPN组瓜氨酸水平较滋养性EN+PN组显著降低(P均<0.05)。标准喂养组、EN+PN组及TPN组患者呕吐/胃潴留发生率比较,差异具有统计学意义[50.0%(19/38)vs.45.0%(18/40)vs.23.1%(9/39),χ^(2)=6.670,P=0.036];而腹胀[52.6%(20/38)vs.45.0%(18/40)vs.48.7%(19/39),χ^(2)=0.454,P=0.797]、腹泻[23.7%(9/38)vs.17.5%(7/40)vs.17.9%(7/39),χ^(2)=0.580,P=0.748]及28 d生存率[55.3%(21/38)vs.65.0%(26/40)vs.61.5%(24/39),χ^(2)=0.792,P=0.673]比较,差异均无统计学意义。此外,标准喂养组和滋养性EN+PN组患者喂养中断情况[60.5%(23/38)vs.47.5%(19/40),χ^(2)=1.331,P=0.249]比较,差异亦无统计学意义。Kaplan-Meier生存曲线结果显示,滋养性EN+PN可以延长7 d内EN持续喂养时间(χ^(2)=3.996,P=0.046)。结论:基于肠道生物标志物在入Objective:Intestinal biomarkers of intestinal fatty acid binding protein(I-FABP),D-lactic acid,and citrulline were used to evaluate the advantages and disadvantages of three nutritional strategies in patients with severe gastrointestinal injury.Methods:A total of 117 patients with severe gastrointestinal injury were selected from the Intensive Care Unit of the Affiliated Suzhou Hospital of Nanjing Medical University from February 2021 to January 2023.All enrolled patients were divided into a standard feeding group(38 cases),a nourishing enteral nutrition(EN)+parenteral nutrition(PN)group(40 cases),and a total parenteral nutrition(TPN)group(39 cases)by a random number table method.Early EN began 24 h after admission.The baseline data,gastrointestinal tolerance,28-day survival rate,and levels of I-FABP,D-lactic acid and citrulline at different time points were compared among the three groups.The incidence of feeding interruption was compared between the standard feeding group and the nourishing EN+PN group.The duration of enteral feeding in the standard feeding group and the nourishing EN+PN group was recorded,and a Kaplan-Meier survival curve was drawn.Results:There were significant differences in the levels of I-FABP,D-lactic acid,and citrulline before EN and on the 3rd and 7th days of admission among the three groups(F=2.772,2.797,7.902;P=0.028,0.027,<0.001).Further pair-to-pair comparison showed that the levels of I-FABP and D-lactic acid in the nourishing EN+PN group were significantly lower than those in the standard feeding group,while the level of I-FABP in the TPN group was significantly higher than that in the nourishing EN+PN group on the 3rd day of admission(all P<0.05).The level of citrulline in the nourishing EN+PN group was significantly higher than that in the standard feeding group and the TPN group on the 7th day after admission(both P<0.05).The incidence of vomiting/gastric retention was significantly different[50.0%(19/38)vs.45.0%(18/40)vs.23.1%(9/39),χ^(2)=6.670,P=0.036],while the incidence of

关 键 词：瓜氨酸 肠型脂肪酸结合蛋白 D-乳酸 重度胃肠损伤 肠内营养 

分 类 号：R459.7[医药卫生—急诊医学]