摘要
目的探讨血清肠型脂肪酸结合蛋白(I-FABP)、D-乳酸水平在脓毒症和脓毒性休克患者早期肠道损伤中的变化及临床意义。方法采用前瞻性观察性研究方法,选择2018年8月至12月宁夏医科大学总医院重症医学科(ICU)收治的30例脓毒症患者(脓毒症组)和30例脓毒性休克患者(脓毒性休克组),并选择同期20例健康体检者作为对照(健康对照组)。收集脓毒症组及脓毒性休克组患者入ICU 24 h内血清样本,健康对照组于体检时收集血清样本,测定血清I-FABP、D-乳酸、内毒素、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和血乳酸(Lac)水平;记录所有研究对象的性别、年龄以及所有患者的基础疾病、主要感染部位及入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),并随访患者28 d生存情况。血清I-FABP、D-乳酸与各项指标的相关性采用Spearman相关分析;采用二分类变量的多因素Logistic回归分析筛选脓毒症和脓毒性休克患者死亡的危险因素。结果各组研究对象间性别、年龄比较差异无统计学意义,脓毒症组与脓毒性休克组间基础疾病、腹腔感染和非腹腔感染疾病构成比差异亦无统计学意义,说明各组间临床基线资料均衡可比。脓毒症组和脓毒性休克组血清I-FABP、D-乳酸水平均明显高于健康对照组〔I-FABP(μg/L):27.46(22.52,34.39)、36.95(29.82,44.24)比17.93(14.65,22.11),D-乳酸(mg/L):15.32(9.84,38.62)、27.95(10.01,47.69)比9.38(8.81,14.48),均P<0.01〕;其中脓毒性休克组血清I-FABP水平明显高于脓毒症组(P<0.05),但两组血清D-乳酸水平差异无统计学意义(P>0.05)。腹腔感染组(40例)血清I-FABP水平明显高于非腹腔感染组〔20例;μg/L:34.76(27.46,43.90)比25.71(20.55,37.77),P<0.01〕,但血清D-乳酸水平比较差异无统计学意义〔mg/L:25.13(9.83,40.55)比30.36(10.17,50.00),P>0.05〕。存活组(34例)与死亡组(26例)患者血清I-FABP和D-乳酸水平比较差异均无统计学意义〔I-FABP(μg/L):33.39(25.20,39.50)比29.26(22.50,43.81),D-乳酸(mg/L):14.83(9.71,38.45)比33.90(11.93,45.34),均P>0.05〕。脓毒症和脓毒性休克患者血清I-FABP、D-乳酸水平与内毒素、炎性因子、Lac、APACHEⅡ的相关分析显示,仅D-乳酸与TNF-α、Lac呈显著正相关(r值分别为0.455、0.406,均P<0.01),而I-FABP与内毒素、炎性因子、Lac和APACHEⅡ评分均无相关性。多因素Logistic回归分析显示,仅APACHEⅡ评分是脓毒症和脓毒性休克患者28 d死亡的独立危险因素〔优势比(OR)=1.248,95%可信区间(95%CI)=1.091~1.427,P=0.001〕,而I-FABP、D-乳酸、内毒素、hs-CRP、TNF-α、IL-6、Lac对患者28 d预后均无影响。结论血清I-FABP、D-乳酸水平可评估脓毒症和脓毒性休克患者早期肠道损伤,但二者均与患者预后无关。
Objective To investigate the changes and clinical significances of intestinal fatty acid binding protein(I-FABP)and D-lactic acid levels in early intestinal injury of patients with sepsis and septic shock.Methods A prospective observational study was conducted.Thirty septic patients(septic group)and 30 septic shock patients(septic shock group)were admitted to the intensive care unit(ICU)of General Hospital of Ningxia Medical University from August 2018 to December 2018,and 20 healthy adults were served as healthy control group.Serum samples were collected within 24 hours after ICU admission in septic shock and septic groups,and in healthy control group during physical examination.The serum I-FABP,D-lactic acid,endotoxin,hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and lactic acid(Lac)were determined.Gender and age of all subjects,and basic diseases,the main area of infection and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores within 24 hours after ICU admission of all patients were recorded.At the same time,the survival of the patients was followed up for 28 days.Spearman correlation analysis was used to analyze the correlation between serum I-FABP,D-lactic acid and other parameters.Risk factors of death in patients with sepsis and septic shock were screened by multivariate Logistic regression analysis of bicategorized variables.Results There was no significant difference in gender or age among the groups,as well as in the proportion of basic diseases,celiac infection or non-celiac infection between the sepsis group and the septic shock group,indicating that the general clinical baseline data among the groups were comparable.Serum levels of I-FABP and D-lactic acid in the sepsis group and the septic shock group were significantly higher than those in the healthy control group[I-FABP(μg/L):27.46(22.52,34.39),36.95(29.82,44.24)vs.17.93(14.65,22.11),D-lactic acid(mg/L):15.32(9.84,38.62),27.95(10.01,47.69)vs.9.38(8.81,14.48),all P<0.01].The serum level of I-FABP in the septic shock group was significantly higher than that in the sepsis group(P<0.05),but the difference in serum D-lactic acid level between the two groups was not statistically significant(P>0.05).Serum I-FABP level in the celiac infection group(n=40)was significantly higher than that in the non-celiac infection group[n=20;μg/L:34.76(27.46,43.90)vs.25.71(20.55,37.77),P<0.01],but the difference in serum D-lactic acid level was not statistically significant[mg/L:25.13(9.83,40.55)vs.30.36(10.17,50.00),P>0.05].There was no significant difference in serum I-FABP or D-lactic acid levels between the survival group(n=34)and the death group[n=26;I-FABP(μg/L):33.39(25.20,39.50)vs.29.26(22.50,43.81),D-lactic acid(mg/L):14.83(9.71,38.45)vs.33.90(11.93,45.34),both P>0.05].Correlation analysis between serum I-FABP,D-lactic acid level and endotoxin,inflammatory factors,Lac and APACHEⅡscore in septic and septic shock patients showed that only D-lactic acid was significantly positively correlated with TNF-αand Lac(r values were 0.455 and 0.406,respectively,both P<0.01),while I-FABP was not correlated with endotoxin,inflammatory factors,Lac or APACHEⅡscore.Multivariable Logistic regression analysis showed the APACHEⅡscore was an independent risk factor to affect the prognosis(death for 28 days)of septic and septic shock patients[odds ratio(OR)=1.248,95%confidence interval(95%CI)=1.091-1.427,P=0.001],while I-FABP,D-lactic acid,endotoxin,hs-CRP,TNF-α,IL-6,and Lac had no impact on 28-day prognosis of patients.Conclusion Serum I-FABP and D-lactic acid levels can evaluate early intestinal injury in patients with sepsis and septic shock,but neither of them is related to the prognosis of patients.
作者
张小彬
刘丹
王妍柏
闫晶
杨晓军
Zhang Xiaobin;Liu Dan;Wang Yanbai;Yan Jing;Yang Xiaojun(Ningxia Medical University.Yinchuan 750004,Ningxia Hui Autonomous Region,China;Cerebraspinal Fluid Laboratory,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region.China;Department of Critical Care Medicine.Geneml Hospital of Ningxia Medical Universitv.Yinchuan 750004,Ningxia Hui Autonomous Region,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第5期545-550,共6页
Chinese Critical Care Medicine
基金
宁夏高等学校一流学科建设(宁夏医科大学国内一流建设学科临床医学)项目(NXYLXK2017A05)
"十三五"国家重点研发计划项目(2016YFD0400605).
