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河北医学  2020, Vol. 26 Issue (8): 1357-1361    DOI: 10.3969/j.issn.1006-6233.2020.08.029
  临床研究 本期目录 | 过刊浏览 | 高级检索 |
肠三叶因子对脓毒性休克患者早期肠功能障碍的评估价值及与病情严重程度的关系
吴昌徽1, 董芸2, 李昌隆1
1. 四川省达州市中心医院重症医学科, 四川 达州 635000
2. 达州中医药职业学院中医内科, 四川 达州 635000
An Evaluation of Intestinal Trefoil Factor on Early Intestinal Dysfunction in Septic Shock Patients and Its Association with Severity of the Disease
WU Changhui, et al
Dazhou Central Hospital, Sichuan Dazhou 635000, China
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摘要 目的: 探讨肠三叶因子(TFF3)对脓毒性休克患者早期肠功能障碍的评估价值, 及其与病情严重程度的关系。方法: 选取2016年11月至2019年10月达州市中心医院重症医学科入院24h内出现脓毒性休克的患者150例作为研究对象, 并根据住院期间是否并发早期肠功能障碍分为非肠功能障碍组(n=72)与肠功能障碍组(n=78)。收集临床资料, 采用双抗体夹心酶联免疫吸附法(ELISA)检测血清TFF3水平。采用Pearson检验分析肠功能障碍患者血清TFF3水平与急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)、C反应蛋白(CRP)、血尿素氮(BUN)、血肌酐(SCr)、胃肠功能评分的相关性;采用二分类变量多因素Logistic回归分析筛选影响脓毒性休克患者并发早期肠功能障碍的独立危险因素;并绘制受试者工作特征曲线(ROC曲线), 评价APACHE Ⅱ评分、SCr、TFF3对脓毒性休克患者并发早期肠功能障碍的预测价值。结果: 肠功能障碍组患者APACHE Ⅱ评分、CRP、BUN、SCr及血清TFF3水平均显著高于非肠功能障碍组患者(P<0.05)。肠功能障碍患者血清TFF3水平与APACHE Ⅱ评分、CRP、BUN、SCr、胃肠功能评分均呈正相关(P<0.05)。多因素Logistic回归分析显示, APACHE Ⅱ评分、SCr及血清TFF3水平升高均是影响脓毒性休克患者并发早期肠功能障碍的独立危险因素(P<0.05)。ROC曲线显示, 血清TFF3水平评估脓毒性休克患者并发早期肠功能障碍的曲线下面积(AUC)高于APACHE Ⅱ评分、SCr, 最佳截断值为12.97 ng/mL时预测敏感度为82.10%, 特异度高达98.60%。结论: 脓毒性休克并发早期肠功能障碍患者血清TFF3水平升高, 可作为评估脓毒性休克患者早期肠功能障碍的血清标记物。
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关键词 脓毒症 脓毒性休克 肠功能障碍 肠三叶因子    
AbstractObjective: To investigate the value of the evaluation of intestinal trefoil factor (TFF3) in early intestinal dysfunction in septic shock patients and its relationship with the severity of the disease. Methods: From November 2016 to October 2019, 150 patients with septic shock within 24 hours after admission in the Department of critical medicine of Dazhou Central Hospital were selected as the study objects. According to whether early intestinal dysfunction was complicated during hospitalization, they were divided into non intestinal dysfunction group (n = 72) and intestinal dysfunction group (n = 78). Clinical data were collected and serum TFF3 was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Pearson test was used to analyze the correlations between serum TFF3 level and Acute Physiology And Chronic Health Evaluation Ⅱ (APACHE Ⅱ), C-reactive protein (CRP), blood urea nitrogen (BUN), blood creatinine (SCr) and gastrointestinal function score; multivariate logistic regression analysis of binary variables was used to screen the independent risk factors of early intestinal dysfunction in septic shock patients; and the ROC curve was drawn to evaluate the predictive values of APACHE Ⅱ score, SCr and TFF3 in patients with septic shock complicated with early intestinal dysfunction. Results: The APACHE Ⅱ score, levels of CRP, BUN, SCr and serum TFF3 of patients in intestinal dysfunction group were significantly higher than those of patients in non intestinal dysfunction group (P<0.05). There was a positive correlation between serum TFF3 level and APACHE Ⅱ score, CRP, BUN, SCr and gastrointestinal function score (P<0.05). Multivariate logistic regression analysis showed that the increases of APACHE Ⅱ score, SCr and serum TFF3 level were independent risk factors for septic shock complicated with early intestinal dysfunction (P<0.05). The ROC curve showed that the area under the curve (AUC) of serum TFF3 level in patients with septic shock complicated with early intestinal dysfunction was higher than that of APACHE Ⅱ score and SCr, and the sensitivity and specificity were 82.10% and 98.60% respectively when the best cutoff value was 12.97 ng/ml. Conclusions: The serum TFF3 level of septic shock patients with early intestinal dysfunction is increased, which can be used as a serum marker to evaluate the early intestinal dysfunction of septic shock patients.
Key wordsSepsis    Septic shock    Intestinal dysfunction    Intestinal trefoil factor
    
基金资助:四川省卫生厅科研基金项目, (编号:170192)
引用本文:   
吴昌徽, 董芸, 李昌隆. 肠三叶因子对脓毒性休克患者早期肠功能障碍的评估价值及与病情严重程度的关系[J]. 河北医学, 2020, 26(8): 1357-1361.
WU Changhui, et al. An Evaluation of Intestinal Trefoil Factor on Early Intestinal Dysfunction in Septic Shock Patients and Its Association with Severity of the Disease. HeBei Med, 2020, 26(8): 1357-1361.
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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.08.029     或     http://www.hbyxzzs.cn/CN/Y2020/V26/I8/1357
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