摘要
目的评价尿中乳果糖／甘露醇比值（LMR）和肠脂肪酸结合蛋白（IFABP）检测对脓毒症患者肠屏障功能损伤的诊断价值以及对患者病情严重程度和预后的评估作用。方法选择首都医科大学附属北京友谊医院中心重症监护病房（ICU）2007年6月－2008年2月收治的38例脓毒症患者，确诊72h内留取尿样，应用高压液相色谱仪－脉冲电化学检测器测定尿LMR值，用酶联免疫吸附法（ELISA）测定尿IFABP浓度，分别按急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分不同分值、是否合并多器官功能障碍综合征（MODS）及28d转归分组，比较两种检测指标的差异，并对两者及胃肠功能评分进行相关性分析。结果38例脓毒症患者尿LMR、IFABP均明显增高。APACHEⅡ评分〉20分组尿LMR高于≤20分组（P=0．056）；合并MODS组及死亡组尿LMR分别高于未合并MODS组与存活组（P均〈0．05）。APACHEI评分〉20分组、合并MODS组、死亡组尿IFABP浓度分别与APACHEI评分≤20分组、未合并MODS组、存活组比较差异无统计学意义。存在应激性溃疡组尿IFABP浓度较无应激性溃疡组明显增高（P〈0．05）。LMR、IFABP、胃肠功能评分间均无显著相关性。结论脓毒症患者存在肠上皮细胞损伤和肠黏膜通透性增高；尿LMR增高对判断患者病情及预后有一定指导作用；尿IFABP浓度与患者病情严重程度及预后无明显相关性；肠黏膜上皮损伤重者尿IFABP浓度也高；LMR、IFABP、胃肠功能评分三者无明显相关关系。
Objective To assess urine lactulose/mannitol ratio （LMR）, and intestinal fatty aeid binding protein （IFABP） eoneentration as the indexes of intestinal damage in septie patients, and to evaluate the clinical severity and mortality of septic patients by use of these indexes. Methods Thirty-eight patients with sepsis were consecutively selected in Beijing Friendship Hospital intensive care unit （ICU） from June 2007 to February 2008, according to the inclusions and exclusions criteria. Urine samples were taken in 72 hours after ICU admission. Urine LMR was determined by high performance liquid chromatography by use of pulsed electrochemical detection （HPLC-PED）, and urine IFABP concentration was determined by enzyme-linked immunosorbent assays （ELISA）. The results of LMR and IFABP were analyzed with acute physiology and chronic health evaluation I （APACHE I ） score, with multiple organ dysfunction syndrome （MODS） or not and outcome on day 28. The relationship between the two indexes and the patients＇ gastrointestinal function score was analyzed. Results Thirty-eight patients included had significantly higher urine level of IFABP concentration and LMR. Urine LMR were higher in patients with APACHE I score 20 than in patients with APACHE I seore≤20 （P= 0. 056）, and the values were significantly higher in patients who with MODS and in nonsurvivors than those in patients who without MODS and in survivors （both P〈0. 05）. Urine IFABP concentration was not found significantly difference in patients with APACHE I score〉20, those with MODS and nonsurvivors, compared with patients with APACHE I seore 420, those without MODS and survivors. Patients with stress ulcer had higher urine IFABP concentration than patients without stress ulcer （P〈0. 05）. There was no correlation among LMR, IFABP and gastrointestinal function score. Conclusion This study reveals that patients with sepsis have intestinal mucosal damage and increased intestinal permeability. Increased LMR in urine is associated with clinical severity and prognosis; urine IFABP concentration is not associated with clinical severity and prognosis. Patients with stress ulcer have higher urine IFABP concentration. There is no correlation among IFABP, LMR and gastrointestinal function score.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2009年第8期470-473,共4页
Chinese Critical Care Medicine
基金
北京市科技重大项目（H020920050530）
关键词
乳果糖/甘露醇比值
肠脂肪酸结合蛋白
脓毒症
胃肠道
laetulose/mannitol ratio
intestinal fatty acid binding protein
sepsis
gastroin- testinal tract
