瓜氨酸、I-FABP、内毒素及PCT与严重创伤后急性胃肠损伤的相关性研究

发布时间：2018-03-26 12:14

本文选题：创伤　切入点：急性胃肠损伤　出处：《兰州大学》2017年硕士论文

【摘要】：目的:本实验通过测定严重创伤后患者不同时间点瓜氨酸、I-FABP、内毒素及PCT水平,观察严重创伤后患者肠粘膜损伤与内毒素移位程度,分析生物学标志物相互之间及与创伤后AGI之间的相关性,并纳入SOFA评分、APACHEⅡ评分,探讨肠粘膜损伤在MODS病理变化过程中作用。方法:采用前瞻性研究方法,纳入2015年8月至2016年12月入住兰州大学第二医院内科ICU创伤后24h内首诊我院的患者(18岁年龄80岁)。排除闭合及开放性腹部创伤、急慢性肠道疾病及胃肠道手术史患者,存在急慢性肾脏、肝脏疾病患者,可疑感染患者,妊娠期妇女。根据创伤严重程度评分ISS分为轻度创伤组(ISS16),重度创伤组(ISS≥16)。根据入院72h内是否发生急性胃肠损伤分为AGI组,AGI0组,根据2012年欧洲危重病医学会对AGI分级指南,对AGI组分为3个亚组,A GI1组,AGI2组,AGI3组。选择同期兰州大学第二医院健康体检者作为正常对照组。收集患者基本临床资料及AGI分级,采集入院第1天及第3天静脉血标本,用于测量瓜氨酸、I-FABP、内毒素及PCT水平。结果:1.第1天重伤组、轻伤组瓜氨酸水平较对照组均显著降低(P0.01或P0.05),且重伤组显著低于轻伤组(P0.01),第3天各组瓜氨酸水平进一步下降(P均0.01),重伤组仍显著低于轻伤组(P0.01)。第1天AGI3组中瓜氨酸水平较AGI0组、AGI1组、AGI2组显著降低(P0.01或P0.05),AGI2、AGI1组也较AGI0组显著下降(P0.01或P0.05)。第3天各组瓜氨酸水平均进一步下降(P均0.01),各亚组间分级越高,瓜氨酸水平下降越显著(P0.01或P0.05)。瓜氨酸水平与AGI严重程度呈负相关。瓜氨酸对严重创伤后AGI预测的ROC曲线下面积为0.88,最佳界值为19.07umol/L,此时敏感性为87.10%,特异性为76.47%.2.第1天重伤组、轻伤组I-FABP水平较对照组显著升高(P均0.01),且重伤组显著高于轻伤组(P0.01)第3天各组I-FABP水平进一步下降(P均0.01),重伤组仍高于轻伤组(P0.05)。第1天AGI3组中I-FABP水平较AGI0组、AGI1组、AGI2组显著升高(P0.01或P0.05),AGI2组也较AGI0组显著升高(P0.01)。第3天AGI0组、AGI2组、AGI3组I-FABP水平均进一步下降(P均0.01),AGI3组、AG2组I-FABP水平仍显著高于AGI0组(P0.01或P0.05)。I-FABP与AGI严重程度呈正相关。I-FABP对严重创伤后AGI预测的ROC曲线下面积为0.84,最佳界值为1657pg/ml,此时敏感性为90.32%,特异性为64.71%。3.第1天重伤组、轻伤组内毒素水平较对照组显著升高(P均0.01),且重伤组显著高于轻伤组(P0.01)第3天各组内毒素水平较第1天变化不明显,差异不具有统计学意义(P0.05),但重伤组仍显著高于轻伤组(P0.01)。第1天AGI3组中内毒素水平较AGI0组、AGI1组、AGI2组显著升高(P0.01或P0.05),AGI2组也较AGI0、AGI1组显著升高(P0.01或P0.05),AGI1组较AGI0组升高(P0.05)。第3天仅AGI0组内毒素水平进一步下降(P0.05),AGI3组内毒素水平仍显著高于AGI0、AGI1组(P0.01),AGI2组仍显著高于AGI0组、AGI1组(P0.01或P0.05),AGI1组水平仍显著高于AGI0组(P0.05)。内毒素水平与AGI严重程度呈正相关。内毒素对严重创伤后AGI预测的ROC曲线下面积为0.90,最佳界值为0.234EU/ml,此时敏感性为90.32%,特异性为82.35%。4.第1天重伤组PCT水平较对照组、轻伤组显著升高(P0.01或P0.05),第3天各组PCT水平较第1天差异不具有统计学意义(P0.05),但重伤组仍高于正常组(P0.05)。第1天仅AGI3组中PCT水平较AGI0组、AGI1组、AGI2组显著升高(P均0.01),第3天其水平与第1天相比差异无统计学意义(P0.05),但AGI3组PCT水平仍高于AGI1、AGI0组(P0.01或P0.05),AGI2组高于AGI0组(P0.01)。5.创伤后瓜氨酸水平与I-FABP、内毒素、PCT、APACHEⅡ评分、SOFA评分呈明显负相关,与I-FABP、内毒素、PCT、APACHEⅡ评分、SOFA评分之间存在明显正相关。入院后72h内手术组第3天的I-FABP水平较非手术组显著升高,存在正相关。结论:创伤后早期血清I-FABP、内毒素、PCT水平显著升高,其水平变化均与创伤严重程度和AGI严重程度程度有明显的正相关,血清瓜氨酸水平显著降低,其水平变化与创伤严重程度和AGI严重程度程度有明显的负相关;APACHEⅡ评分、SOFA评分与瓜氨酸水平呈明显负相关,与I-FABP、内毒素、PCT之间存在明显正相关,瓜氨酸、I-FABP、内毒素、PCT相关之间存在明显相关性;瓜氨酸、I-FABP、内毒素水平可以作为是预测创伤后早期肠粘膜损伤的潜在生物学标志物。
[Abstract]:Objective: through the determination of severe trauma patients at different time points of I-FABP, citrulline, endotoxin and PCT levels were observed after severe trauma patients with intestinal mucosal injury and endotoxin translocation, biological analysis of correlations of biomarkers between and after trauma and AGI, and included in the SOFA score, APACHE score, to explore the role of intestinal mucosa in MODS during the pathological process of injury. Methods: the prospective study included in August 2015 to December 2016 in Second Hospital Affiliated to Lanzhou University, medical ICU 24h after trauma in our hospital diagnosed patients (aged 18 years old 80 years old). Exclusion of closed and open abdominal trauma, acute and chronic bowel disease and gastrointestinal surgery patients had acute and chronic patients with kidney, liver disease, patients with suspected infection in pregnant women. According to the injury severity score ISS were divided into mild trauma group (ISS16), severe trauma group (ISS = 16). According to the admission 72h is the occurrence of acute gastrointestinal injury were divided into AGI group, AGI0 group, according to the 2012 European Society of critical care medicine on AGI classification guide, the AGI were divided into 3 groups, A GI1 group, AGI2 group, AGI3 group. The Second Hospital Affiliated to Lanzhou University selected healthy subjects as normal control group were collected. The basic clinical the data acquisition and AGI classification, the first day of admission and 3 days blood samples for the measurement of citrulline, I-FABP, endotoxin and PCT level. Results: 1. of first days of severe injury group, the level of citrulline group were significantly decreased slightly compared with the control group (P0.01 or P0.05), and the severe injury group was significantly lower than that in slight group (P0.01), third days the citrulline levels were further decreased (P 0.01), severe injury group was significantly lower than that in slight group (P0.01). First days in group AGI3 citrulline levels compared with AGI0 group, AGI1 group, AGI2 group significantly decreased (P0.01 or P0.05), AGI2, AGI1 group was significantly lower than that in AGI0 group (P0.01 or P0. 05). Third days each were further reduced citrulline levels (P 0.01), among the sub groups with the higher grade of citrulline levels decreased more remarkably (P0.01 or P0.05). The level of citrulline was negatively correlated with the severity of AGI. The area of ROC AGI citrulline curve prediction after severe trauma was 0.88, the best cut-off value for 19.07umol/L, the sensitivity was 87.10%, specificity was first days 76.47%.2. injured group, the level of I-FABP minor injury group were significantly higher than the control group (P 0.01), and the severe injury group was significantly higher than that in slight group (P0.01) third days the level of I-FABP was further decreased (P 0.01), severe injury group was still higher than the minor injury group (P0.05) first days in the AGI3 group. The level of I-FABP compared with AGI0 group, AGI1 group, AGI2 group increased significantly (P0.01 or P0.05), AGI2 group was significantly higher than that of AGI0 group (P0.01). Third days in AGI0 group, AGI2 group, the level of I-FABP in AGI3 group were further decreased (P 0.01), AGI3 group, the level of I-FABP AG2 group is significantly higher In the AGI0 group (P0.01 or P0.05).I-FABP and AGI were positively correlated with the severity of.I-FABP ROC curve area prediction of AGI after severe trauma was 0.84, the optimum value of 1657pg/ml, the sensitivity was 90.32%, specificity was first days 64.71%.3. injury group, the levels of endotoxin in minor injury group than the control group increased significantly (P < 0.01), and the severe injury group was significantly higher than that in slight group (P0.01) were compared with third days of endotoxin first days did not change significantly, the difference was not statistically significant (P0.05), but the injured group was still higher than that of minor injury group (P0.01). First days in group AGI3 endotoxin levels compared with AGI0 group, AGI1 group, AGI2 group significantly increased (P0.01 or P0.05), AGI2 group was AGI0, AGI1 group increased significantly (P0.01 or P0.05), the AGI1 group was higher than that in AGI0 group (P0.05). The third day only AGI0 group further decreased levels of endotoxin (P0.05), the levels of endotoxin in AGI3 group was still significantly higher than that in AGI0 group, AGI1 (P0.01), AGI2 group was still higher high In AGI0 group, AGI1 group (P0.01 or P0.05), AGI1 group was still higher than that of AGI0 group (P0.05). The level of endotoxin was positively correlated with the degree of AGI. LPS on ROC curve area prediction of AGI after severe trauma was 0.90, the optimum value of 0.234EU/ml, the sensitivity was 90.32%, specificity was first 82.35%.4. days of severe injury group PCT levels than the control group, injury group increased significantly (P0.01 or P0.05), the level of PCT was third days compared to first days the difference was not statistically significant (P0.05), but the injured group still higher than the normal group (P0.05). Only first days in the AGI3 group PCT levels compared with AGI0 group, AGI1 group, AGI2 group increased significantly (P 0.01) third days, first days compared with the level of the difference was not statistically significant (P0.05), but the PCT level of AGI3 group was higher than AGI1, AGI0 group (P0.01 or P0.05), AGI2 group than in AGI0 group (P0.01) and citrulline levels I-FABP,.5. after trauma of endotoxin, PCT, APACHE score the SOFA score was. Significant negative correlation with I-FABP, endotoxin, PCT, APACHE score, there was a positive correlation between SOFA scores. 72h after admission surgery group third days I-FABP levels than the non operation group increased significantly, there is a positive correlation. Conclusion: early after trauma and endotoxin, serum I-FABP, PCT levels significantly increased significantly the level changes were positively correlated with the extent of injury and severity of AGI, serum citrulline levels were significantly reduced, there was a negative correlation between the severity and the AGI level and the severity of injury degree; APACHE score, SOFA score was negatively correlated with I-FABP, endotoxin and citrulline levels, there was a positive correlation. PCT I-FABP, citrulline, endotoxin, there is obvious correlation between PCT; citrulline, I-FABP, endotoxin levels can be used as potential biomarkers for early prediction of intestinal mucosal injury after trauma.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R641

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