血清iFABP和DAO对脓毒症及脓毒症肠道损伤的诊断及预后评判价值  

Diagnostic and prognostic value of serum iFABP and DAO on sepsis and intestinal barrier dysfunction with sepsis

作　　者：李志华 于湘友[1] 王毅[1] 银乐乐 LI Zhihua;YU Xiangyou;WANG Yi;YIN Lele(Critical Medicine Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;The Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院重症医学中心,新疆乌鲁木齐830054 [2]新疆医科大学第五附属医院,新疆乌鲁木齐830054

出　　处：《海南医科大学学报》2025年第4期270-276,共7页Journal of Hainan Medical University

基　　金：国家自然科学基金资助项目(82160360)。

摘　　要：目的:探讨脓毒症患者外周血清肠道脂肪酸结合蛋白(iFABP)以及二胺氧化酶(DAO)水平与肠道屏障功能障碍的关系。方法:本研究选择脓毒症患者(n=129)和同期健康体检者(n=129)作为研究对象,采用ELISA方法检测外周血清DAO和iFABP表达水平。根据AGI评分将脓毒症患者分为脓毒症AGI组和脓毒症非AGI组,比较两组DAO、iFABP表达水平。采用Logistic回归分析外周血清DAO和iFABP表达水平与肠道功能障碍发生的关系。根据患者28 d的生存状况,将其分为存活组(n=93)和死亡组(n=36),运用Cox风险回归分析影响脓毒症患者预后的危险因素,并进一步绘制受试者工作特征曲线,评估外周血清DAO和iFABP表达水平对脓毒症患者的预后评估价值。结果:脓毒症患者外周血清DAO和iFABP表达水平明显高于健康对照组,且AGI组脓毒症患者外周血清DAO和iFABP表达水平高于非AGI组;Logistic回归分析显示iFABP与肠道功能障碍的OR值为1.075,DAO与肠道功能障碍的OR值为1.196;ROC曲线分析显示,iFABP截断值为410.178时,AUC为0.877 (95%CI:0.812~0.942),敏感度为84.90%,特异度为82.90%;DAO截断值为3.473时,AUC为0.606 (95%CI:0.500~0.712),敏感度为64.20%,特异度为68.40%。Cox多因素分析结果提示外周血清DAO和iFABP水平、APACHEⅡ评分是影响脓毒症患者预后的独立危险因素;DAO评估患者预后的ROC曲线下面积为0.985,此时其截断值为3.99,敏感度为97.2%,特异度为92.5%;iFABP评估患者预后的ROC曲线下面积为0.654,此时其截断值为418.36,敏感度为61.1%,特异度为84.9%。结论:脓毒症患者外周血DAO和iFABP表达水平显著升高,与脓毒症引起的肠道损伤密切相关,同时外周血DAO和iFABP表达水平与脓毒症患者的预后密切相关。Objective:To investigate the relationship between intestinal barrier dysfunction and the levels of enteric fatty acid binding protein(iFABP)and diamine oxidase(DAO)in peripheral blood of patients with sepsis.Methods:Sepsis patients(n=129)and healthy subjects(n=129)were selected as subjects,and the expression levels of DAO and iFABP in peripheral blood were detected by ELISA.According to AGI score,sepsis patients were divided into a sepsis AGI group and a sepsis non-AGI group, and DAO and iFABP expression levels were compared between the two groups. Logistic regression was used to analyzethe relationship between DAO and iFABP expression levels in peripheral blood and intestinal dysfunction. Patients were divided intoa survival group (n=93) and a death group (n=36) according to their survival status at 28 d. Cox risk regression analysis wasused to analyze the risk factors affecting the prognosis of patients with sepsis, and the working characteristic curve of subjects wasfurther drawn to evaluate the expression levels of peripheral blood DAO and iFABP in patients with sepsis.Results: The expressionlevels of peripheral blood DAO and iFABP of patients with sepsis were higher than those of the healthy control group, and theexpression levels of peripheral blood DAO and iFABP of patients with sepsis in the AGI group were higher than those in the non-AGI group. Logistic regression analysis showed that the OR value between iFABP and intestinal dysfunction was 1.075, and thatbetween DAO and intestinal dysfunction was 1.196. ROC curve analysis showed that when iFABP cut-off value was 410.178,AUC was 0.877( 95% CI: 0.812-0.942), sensitivity was 84.90%, and specificity was 82.90%. When DAO truncation value was3.473, AUC was 0.606 (95% CI: 0.500-0.712), sensitivity was 64.20%, and specificity was 68.40%. Cox multivariate analysisindicated that DAO and iFABP levels in peripheral blood and APACHEⅡ score were independent risk factors affecting the prognosisof sepsis patients. The area under ROC curve for the prognosis of patien

关 键 词：脓毒症 肠道损伤 肠道脂肪酸结合蛋白(FABP) 二胺氧化酶(DAO) 

分 类 号：R459.7[医药卫生—急诊医学]