摘要
目的探讨联合检测白细胞计数、D-二聚体、组氨酸脱羧酶(HDC)、肠脂肪酸结合蛋白(I-FABP)在急性肠梗阻诊断中的临床应用价值。方法前瞻性选取2017年1月-2018年1月吉林大学中日联谊医院收治的60例患者,其中绞窄性肠梗阻患者20例(绞窄性肠梗阻组)、单纯性肠梗阻患者20例(单纯性肠梗阻组)及腹膜炎患者20例(腹膜炎组),另选取20例健康自愿者作为正常对照组。采用全自动血细胞分析仪检测白细胞计数,采用免疫比浊法检测血浆D-二聚体浓度,采用酶联免疫吸附试验(ELISA)检测血清HDC和I-FABP浓度,比较4组样本的上述指标。计量资料以均数±标准差(Mean±SD)表示;组间比较采用Tamhane’s T2和Dunnett’s T3方法;利用logistic回归模型估计受试者操作特征曲线(ROC)数据及其曲线下面积(AUC)。结果正常对照组白细胞计数为(6.97±1.68)×10^9/L,单纯性肠梗阻组、腹膜炎组和绞窄性肠梗阻组分别为(8.24±2.78)×10^9/L、(11.33±4.75)×10^9/L和(12.53±5.96)×10^9/L。绞窄性肠梗阻组和腹膜炎组白细胞计数均显著高于正常对照组,差异具有统计学意义(F=12.74,P=0.01)。单纯性肠梗阻组与正常对照组之间比较,差异无统计学意义(P>0.05)。正常对照组血浆D-二聚体浓度为(0.44±0.30)μg/ml,单纯性肠梗阻组、腹膜炎组和绞窄性肠梗阻组分别为(1.17±0.67)、(1.20 4±0.72)、(1.67±0.67)μg/ml。绞窄性肠梗阻组血浆D-二聚体浓度显著高于正常对照组,差异具有统计学意义(F=57.08,P=0.00),其余组和对照组比较差异无统计学意义(P>0.05)。正常对照组血清HDC浓度为(5.51±4.30)ng/ml,单纯性肠梗阻组、腹膜炎组、绞窄性肠梗阻组分别为(14.33±3.71)、(11.53±4.67)、(35.65±21.15)ng/ml。绞窄性肠梗阻时血清HDC浓度显著升高,与其他3组相比较,差异具有统计学意义(F=39.03,P=0.00)。正常对照组血清I-FABP浓度为(0.20±0.06)ng/ml,单纯性肠梗阻组、腹膜炎组和绞窄性肠梗阻组分别为(0.31±0.17)、(0.22±0.03)、(0.81±0.56)ng/ml。绞窄性肠梗阻时血清I-FABP浓度显著升高,与其他3组相比较,差异具有统计学意义(F=23.07,P=0.01)。血清HDC、I-FABP和血浆D-二聚体、自细胞计数的AUC分别为0.998、0.868、0.730、0.704。结论白细胞计数、D-二聚体和HDC或I-FABP联合检测是一种更为有效的诊断急性肠梗阻的指标。
Objective To investigate the clinical values of the leukocyte count,D-dimer,histidine decarboxylase (HDC)and intestinal fatty acid binding protein(I-FABP)for diagnosing acute intestinal obstruction. Methods Sixty patients who treated in China-Japan Union Hospital of Jilin University from January 2017 to January 2018 were collected prospectively,and were divided into strangulated intestinal obstruction (STR-IO)group (n =20 ),simple intestinal obstruction (SIM-IO )group (n =20 )and peritonitis group (n =20 ).Twenty healthy volunteers were collected as control group.Automatic blood cell analyzer was used to detecting the leukocyte count. The concentration of plasma D-dimer was detected by immune turbidimetry method.The concentration of serum HDC and I-FABP were measured by enzyme linked immunosorbent assay (ELISA)method.Compared the above indicators of four groups of samples.The measurement data are expressed as mean ±standard deviation (Mean ± SD).Tamhane's T2 and Dunnett's T3 methods were used to comparison between groups.Estimation of receiver operating characteristic curve(ROC)and area under curve (AUC)used logistic regressive model.Results The leukocyte count in control group,SIM-IO group,peritonitis group,and STR-IO group were (6.97 ±1.68 )×10^9/ L,(8.24±2.78)×10^9/L,(11.33±4.75)×10^9/L,and(12.53 ±5.96)×10^9/Lrespectively.STR-IO group and peritonitis group were significantly higher than those of control group(F =12.74,P =0.01 ),but there was no significant difference between SIM-IO group and control group (P >0.05 ).The concentration of plasma D-dimer in control group,SIM-IO group,peritonitis group,and STR-IO group were (0.44 ±0.30)μg/ml,(1.17±0.67)μg/ml,(1.20±0.72)μg/ml,and (1.67±0.67)μg,/ml respectively.The concentration of D-dimer in STR-IO group was significantly higher than those of control group (F =57.08,P =0.00 ),and there was no significant difference among other group(P >0.05 ).The concentration of serum HDC in control group,SIM-IO group,peritonitis group,and STR-IO group were (5.51±4.30)ng/ml,(14.33±3.71)ng/ml,(11.53±4.67)ng/ml,and (35.65 ±21.15)ng/ml respectively.The concentration of HDC in STR-IO group was significantly higher than those of other three groups (F =39.03,P =0.00).The concentration of serum I-FABP in control group,SIM-IO group,peritonitis group,and STR-IO group were (0.20 ±0.06)ng/ml,(0.31±0.17)ng/ml,(0.22±0.03)ng/ml,and (0.81±0.56)ng/ml respectively.The concentration of I-FABP in STR- IO group was significantly higher than those of other three groups (F =23.07,P =0.01 ).The AUC of HDC, 1-FABP,D-dimer,and leukoeyte count were 0.998,0.868,0.730,and 0.704 respactively.Conclusion Leukoeyte count,D-direct,and HDC or I-FABP combined detection may be a more effective index for diagnosing acute intestinal obstruction.
作者
金殷植
马连飞
吴浩利
陈明浩
Jin Yinzhi;Ma Lianfei;Wu Haoli;Chen Minghao(Department of Gastrointestinal Colorectal and Anal Surgery,China-Japan Union Hospital of Jilin University, Changchun 130031,China)
出处
《国际外科学杂志》
2019年第1期52-56,共5页
International Journal of Surgery
基金
吉林省直卫生专项项目(SCZSY201526).
关键词
肠梗阻
诊断
组氨酸脱羧酶
肠脂肪酸结合蛋白
D-二聚体
Intestinal obstruction
Diagnosis
Histidine decarboxylase
Intestinal fatty acid binding protein
D-dimer
