中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
6期
420-424
,共5页
朱承睿%丁仁彧%孙旖旎%马晓春
硃承睿%丁仁彧%孫旖旎%馬曉春
주승예%정인욱%손의니%마효춘
肠脂肪酸结合蛋白%严重脓毒症%急性胃肠功能损伤
腸脂肪痠結閤蛋白%嚴重膿毒癥%急性胃腸功能損傷
장지방산결합단백%엄중농독증%급성위장공능손상
Intestinal fatty acid binding protein%Severe sepsis%Acute gastrointestinal injury
目的 探讨严重脓毒症患者血清肠脂肪酸结合蛋白(IFABP)浓度变化及临床意义.方法 采用前瞻性观察性研究方法,选择2012年7月至12月入住中国医科大学附属第一医院重症监护病房(ICU)严重脓毒症患者50例,同期选取本院健康体检者20例作为对照组,患者入ICU时及1d、3d采用酶联免疫吸附试验(ELISA)测定血清IFABP浓度及炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度,并计算患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭评分(SOFA),记录28 d生存情况,同时对患者进行急性胃肠损伤(AGI)分级.分别比较健康对照组与严重脓毒症组、腹腔感染组与非腹腔感染组、存活组与死亡组、不同AGI分级组间IFABP浓度的差异;并对IFABP与炎症因子、评分、ICU住院时间、机械通气时间进行相关性分析;对患者28d预后进行多因素logistic回归分析.结果 入ICU时及1d、3d,严重脓毒症患者血清IFABP浓度明显高于健康对照组(mg/L:731.90±53.91、592.07±41.94、511.85±47.97比439.88±23.68,均P=0.000);腹腔感染组与非腹腔感染组、存活组与死亡组、不同AGI分级组间各时间点IFABP浓度差异均无统计学意义.相关分析显示,严重脓毒症患者IFABP与IL-6 (r=0.794,P=0.000)、TNF-α(r=0.878,P=0.010)、APACHEⅡ评分(r=0.428,P=0.000)均有显著相关性;腹腔感染组IFABP与IL-6(r=0.812,P=0.000)、TNF-α (r=0.885,P=0.000)及非腹腔感染组IFABP与IL-6(r=0.739,P=0.000)和TNF-α(r=0.828,P=0.000)相关性较好.多因素logistic回归分析显示,入ICU时及1d、3 d SOFA评分为严重脓毒症患者28 d死亡的独立危险因素,优势比(OR)分别为1.624(P=0.004)、1.411(P=0.027)、1.740(P=0.012),而IFABP浓度、AGI分级、APACHEⅡ评分对患者预后无明显影响.结论 严重脓毒症患者血清IFABP浓度明显增高,与IL-6、TNF-α、APACHEⅡ评分存在较好相关性,与AGI分级及患者预后无明显相关性.
目的 探討嚴重膿毒癥患者血清腸脂肪痠結閤蛋白(IFABP)濃度變化及臨床意義.方法 採用前瞻性觀察性研究方法,選擇2012年7月至12月入住中國醫科大學附屬第一醫院重癥鑑護病房(ICU)嚴重膿毒癥患者50例,同期選取本院健康體檢者20例作為對照組,患者入ICU時及1d、3d採用酶聯免疫吸附試驗(ELISA)測定血清IFABP濃度及炎癥因子白細胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)濃度,併計算患者急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分及序貫器官衰竭評分(SOFA),記錄28 d生存情況,同時對患者進行急性胃腸損傷(AGI)分級.分彆比較健康對照組與嚴重膿毒癥組、腹腔感染組與非腹腔感染組、存活組與死亡組、不同AGI分級組間IFABP濃度的差異;併對IFABP與炎癥因子、評分、ICU住院時間、機械通氣時間進行相關性分析;對患者28d預後進行多因素logistic迴歸分析.結果 入ICU時及1d、3d,嚴重膿毒癥患者血清IFABP濃度明顯高于健康對照組(mg/L:731.90±53.91、592.07±41.94、511.85±47.97比439.88±23.68,均P=0.000);腹腔感染組與非腹腔感染組、存活組與死亡組、不同AGI分級組間各時間點IFABP濃度差異均無統計學意義.相關分析顯示,嚴重膿毒癥患者IFABP與IL-6 (r=0.794,P=0.000)、TNF-α(r=0.878,P=0.010)、APACHEⅡ評分(r=0.428,P=0.000)均有顯著相關性;腹腔感染組IFABP與IL-6(r=0.812,P=0.000)、TNF-α (r=0.885,P=0.000)及非腹腔感染組IFABP與IL-6(r=0.739,P=0.000)和TNF-α(r=0.828,P=0.000)相關性較好.多因素logistic迴歸分析顯示,入ICU時及1d、3 d SOFA評分為嚴重膿毒癥患者28 d死亡的獨立危險因素,優勢比(OR)分彆為1.624(P=0.004)、1.411(P=0.027)、1.740(P=0.012),而IFABP濃度、AGI分級、APACHEⅡ評分對患者預後無明顯影響.結論 嚴重膿毒癥患者血清IFABP濃度明顯增高,與IL-6、TNF-α、APACHEⅡ評分存在較好相關性,與AGI分級及患者預後無明顯相關性.
목적 탐토엄중농독증환자혈청장지방산결합단백(IFABP)농도변화급림상의의.방법 채용전첨성관찰성연구방법,선택2012년7월지12월입주중국의과대학부속제일의원중증감호병방(ICU)엄중농독증환자50례,동기선취본원건강체검자20례작위대조조,환자입ICU시급1d、3d채용매련면역흡부시험(ELISA)측정혈청IFABP농도급염증인자백세포개소-6(IL-6)、종류배사인자-α(TNF-α)농도,병계산환자급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분급서관기관쇠갈평분(SOFA),기록28 d생존정황,동시대환자진행급성위장손상(AGI)분급.분별비교건강대조조여엄중농독증조、복강감염조여비복강감염조、존활조여사망조、불동AGI분급조간IFABP농도적차이;병대IFABP여염증인자、평분、ICU주원시간、궤계통기시간진행상관성분석;대환자28d예후진행다인소logistic회귀분석.결과 입ICU시급1d、3d,엄중농독증환자혈청IFABP농도명현고우건강대조조(mg/L:731.90±53.91、592.07±41.94、511.85±47.97비439.88±23.68,균P=0.000);복강감염조여비복강감염조、존활조여사망조、불동AGI분급조간각시간점IFABP농도차이균무통계학의의.상관분석현시,엄중농독증환자IFABP여IL-6 (r=0.794,P=0.000)、TNF-α(r=0.878,P=0.010)、APACHEⅡ평분(r=0.428,P=0.000)균유현저상관성;복강감염조IFABP여IL-6(r=0.812,P=0.000)、TNF-α (r=0.885,P=0.000)급비복강감염조IFABP여IL-6(r=0.739,P=0.000)화TNF-α(r=0.828,P=0.000)상관성교호.다인소logistic회귀분석현시,입ICU시급1d、3 d SOFA평분위엄중농독증환자28 d사망적독립위험인소,우세비(OR)분별위1.624(P=0.004)、1.411(P=0.027)、1.740(P=0.012),이IFABP농도、AGI분급、APACHEⅡ평분대환자예후무명현영향.결론 엄중농독증환자혈청IFABP농도명현증고,여IL-6、TNF-α、APACHEⅡ평분존재교호상관성,여AGI분급급환자예후무명현상관성.
Objective To investigate the content of intestinal fatty acid binding protein (IFABP) and its clinical significance in patients with severe sepsis.Methods A prospective observational study was conducted.Fifty patients with severe sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from July to December 2012 were enrolled,and 20 healthy patients served as control group.The concentrations of serum IFABP,interleukin-6 (IL-6),and tumor necrosis factor-α (TNF-α) were determined with enzyme-linked immunosorbent assay (ELISA) on days 0,1 and 3 after ICU admission.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score,28-day prognosis,acute gastrointestinal injury (AGI) grade were recorded at the same time.Furthermore,the contents of IFABP were compared between control group and the severe sepsis group,abdominal infection group and non-abdominal infection group,the survival group and the death group,as well as among different AGI-grade groups.Correlation analysis of IFABP and inflammatory factors,IFABP and two scores,and IFABP and time of stay in ICU and mechanical ventilation were studied.Multivariate logistic regression and analysis of 28-day outcome of the patients were also studied.Results IFABP levels were increased in severe sepsis patients on days 0,1 and 3 compared with those of healthy control group (mg/L:731.90 ±53.91,592.07 ±41.94,511.85 ±47.97 vs.439.88 ±23.68,all P =0.000).There was no statistical significance of IFABP levels between abdominal infection group and non-abdominal infection group,the survival group and the death group,or among different AGI-grade groups.The correlation analysis showed that IFABP was statistically related with IL-6 (r=0.794,P=0.000),TNF-α (r=0.878,P=0.010),APACHE Ⅱ score (r=0.428,P=0.000) in patients with severe sepsis.Significant correlations were also found between IFABP and IL-6 (r=0.812,P=0.000),TNF-α (r=0.885,P=0.000) in abdominal infection group,as well as in non-abdominal infection group (IL-6:r=0.739,P=0.000; TNF-α:r=0.828,P=0.000).As shown by multivariate logistic regression analysis,SOFA scores on days 0,1,3 were the independent risk factors for death [odds ratio (OR) was 1.624 (P=0.004),1.411 (P=0.027),1.740 (P=0.012),respectively],but IFABP level,AGI grade,and APACHE Ⅱ score had no influence on death rate.Conclusion IFABP concentrations in patients with severe sepsis were significantly increased,and it is correlated well to IL-6,TNF-α and APACHE Ⅱ score,but did not related obviously with AGI grade and the prognosis of the patients.
