CAJ | 학술논문

目的筛选诊断肠屏障功能障碍特异度和敏感度较高的监测指标.方法收集存在肠屏障功能障碍且急性生理学及慢性健康状况(APACHE)Ⅱ评分≥8分的危重症患者70例及同期无肠屏障功能障碍且APACHEⅡ评分≤6分的患者41例.记录患者一般情况、病史、症状、体征、24 h尿量、机械通气治疗情况.留取静脉血,部分用于细菌培养,部分用于测定白细胞计数、肌酐水平、二胺氧化酶(DAO)活性、D-乳酸水平、肠脂肪酸结合蛋白(IFABP)水平、内毒素水平.留取尿液,测定尿IFABP水平.留取24 h尿液,测定24 h尿IFABP总量.对可能的肠屏障功能障碍影响因素进行单因素分析(计量资料行t检验,计数资料行x2检验)和多因素分析,并以ROC曲线评价筛选出的影响因素.结果与肠屏障功能障碍相关的因素为白细胞计数(OR=3.971,P=0.046)、血内毒素水平(OR=7.857,P=0.005)、24 h尿IFABP总量(OR=11.154,P=0.001).以血内毒素水平和24 h尿IFABP总量来推测肠屏障功能障碍的ROC曲线下面积值分别为0.852和0.820(P均＜0.01),其最佳临界值分别为8.0 pg/ml和17.12 ng,其敏感度分别为97.8％和84.4％,其特异度分别为66.7％和72.7％.结论危重症患者出现消化道症状和体征,同时有血内毒素水平增高(＞8.0 pg/ml)和(或)24 h尿IFABP总量＞17.12 ng,提示可能发生肠屏障功能障碍.
목적 사선진단장병장공능장애특이도화민감도교고적감측지표.방법 수집존재장병장공능장애차급성생이학급만성건강상황(APACHE)Ⅱ평분≥8분적위중증환자70례급동기무장병장공능장애차APACHEⅡ평분≤6분적환자41례.기록환자일반정황、병사、증상、체정、24 h뇨량、궤계통기치료정황.류취정맥혈,부분용우세균배양,부분용우측정백세포계수、기항수평、이알양화매(DAO)활성、D-유산수평、장지방산결합단백(IFABP)수평、내독소수평.류취뇨액,측정뇨IFABP수평.류취24 h뇨액,측정24 h뇨IFABP총량.대가능적장병장공능장애영향인소진행단인소분석(계량자료행t검험,계수자료행x2검험)화다인소분석,병이ROC곡선평개사선출적영향인소.결과 여장병장공능장애상관적인소위백세포계수(OR=3.971,P=0.046)、혈내독소수평(OR=7.857,P=0.005)、24 h뇨IFABP총량(OR=11.154,P=0.001).이혈내독소수평화24 h뇨IFABP총량래추측장병장공능장애적ROC곡선하면적치분별위0.852화0.820(P균＜0.01),기최가림계치분별위8.0 pg/ml화17.12 ng,기민감도분별위97.8％화84.4％,기특이도분별위66.7％화72.7％.결론 위중증환자출현소화도증상화체정,동시유혈내독소수평증고(＞8.0 pg/ml)화(혹)24 h뇨IFABP총량＞17.12 ng,제시가능발생장병장공능장애.
Objective To screen the high specific and sensitive monitoring indications in the diagnosis of intestinal barrier dysfunction.Methods A total of 70 critical patients with intestinal barrier dysfunction and acute physiology and chronic health evaluation (APACHE) Ⅱ score≥8 and over the same period 41 patients without intestinal barrier dysfunction and APACHE Ⅱ score≤6 were recruited.The general information,histories,symptoms,physical signs,24 hours urine output and the condition of mechanical ventilation treatment were recorded.The venous blood was taken for bacteria culture,white blood cell counting,creatinine level,diamine oxidase (DAO) activity,D-lactic acid,intestinal fatty acid binding protein (IFABP) and endotoxin level testing.The urine was taken for urinary IFABP level testing.Twenty-four hours urine was reserved for 24 hours total urinary IFABP testing.The factors which might influence intestinal barrier dysfunction were analyzed by univariate analysis and multivariate analysis.The measurement data were analyzed by t test and the count data were analyzed by x2 test.The factors were screened according to receiver operating characteristic (ROC) curve.Results The factors related with intestinal barrier dysfunction were white blood cell counting (OR=3.971,P=0.046),plasma endotoxin level (OR=7.857,P=0.005)and 24 hours total urinary IFABP (OR=11.154,P=0.001).The areas under the ROC curve (AUC)of plasma endotoxin level and 24 hours total urinary IFABP were 0.852 and 0.820 respectively (both P＜0.01).The critical value was 8.0 pg/ml and 17.12 ng respectively.The sensitivity was 97.8％ and 84.4％.The specificity was 66.7％ and 72.7％.Conclusion Once critical patients presented certain gastrointestinal symptoms and physical signs with plasma endotoxin level ＞8.0 pg/ml and or 24 hours total urinary IFABP ＞17.12 ng,which might indicate intestinal barrier dysfunction.