Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Ann Surg. 2012 Apr;255(4):796-803. doi: 10.1097/SLA.0b013e31824b1e16.
This study evaluated the usefulness of plasma intestinal fatty-acid binding protein (IFABP) levels in the early identification of intestinal necrosis (IN) in patients undergoing different types of aortic surgery.
Intestinal compromise greatly contributes to postoperative adverse outcome. IN is the most detrimental form of intestinal compromise and is notoriously difficult to diagnose. IFABP is a small protein exclusively expressed by mature enterocytes and a promising marker of intestinal damage.
Plasma IFABP concentrations were measured in blood samples taken perioperatively from 55 patients undergoing open thoracic or thoracoabdominal aneurysm repair [OR-TAA(A)], 25 patients undergoing conventional open abdominal aneurysm repair (OR-abdominal aortic aneurysm [AAA]), and 16 patients undergoing endovascular aneurysm repair (EVAR). Data were compared with perioperative changes in arterial pH and serum lactate levels.
IFABP levels increased in all patients undergoing OR-TAA(A) and OR-AAA reaching peak levels shortly after surgery; 281 ± 33 to 2,298 ± 490 pg/mL (P < 0.001) and 187 ± 31 to 641 ± 176 pg/mL (P < 0.05) respectively. IFABP levels were significantly higher in patients undergoing OR-TAA(A) (P < 0.001). IFABP levels in EVAR patients remained at baseline concentrations throughout the study. Four patients [2 OR-AAA, 2 OR-TAA(A)] developed fatal postoperative intestinal ischemia on day 2 or 3. High levels of plasma IFABP at the end of surgery had 100% sensitivity and 98.1% specificity for the identification of patients developing IN. In OR-AAA patients, arterial pH and lactate levels were of additional discriminating value. Complete discrimination between patients with and without IN using plasma IFABP could be made on the first postoperative day.
Analysis of plasma IFABP levels is of additional value to other current plasma markers in the diagnosis of IN, and it enables early identification of patients with IN after aortic surgery days before clinical diagnosis.
本研究评估了血浆肠脂肪酸结合蛋白（IFABP）水平在识别不同类型主动脉手术后肠坏死（IN）中的作用。
肠道受损极大地影响术后不良结局。IN 是最具危害性的肠道损伤形式，诊断极具挑战性。IFABP 是一种由成熟肠细胞特异性表达的小蛋白，是一种有前途的肠道损伤标志物。
对 55 例行开放胸或胸腹主动脉瘤修复术（OR-TAA(A)）、25 例行传统开放腹主动脉瘤修复术（OR-腹主动脉瘤 [AAA]）和 16 例行血管内动脉瘤修复术（EVAR）的患者，在围手术期采集血液样本，检测血浆 IFABP 浓度。并将其与动脉 pH 和血清乳酸水平的变化进行比较。
所有接受 OR-TAA(A)和 OR-AAA 手术的患者 IFABP 水平均升高，术后短时间内达到峰值水平；分别从 281±33 至 2298±490 pg/mL（P<0.001）和 187±31 至 641±176 pg/mL（P<0.05）。OR-TAA(A)组患者的 IFABP 水平明显更高（P<0.001）。EVAR 组患者的 IFABP 水平在整个研究过程中保持基线浓度。4 例患者（2 例 OR-AAA，2 例 OR-TAA(A)）在术后第 2 或第 3 天发生致命性术后肠缺血。手术结束时 IFABP 水平升高 100%敏感，98.1%特异，可识别发生 IN 的患者。在 OR-AAA 患者中，动脉 pH 和乳酸水平具有额外的鉴别价值。使用 IFABP 可在术后第 1 天即可完全区分有无 IN 的患者。
IFABP 水平分析对其他当前的血浆标志物在 IN 的诊断中具有附加价值，它可以在主动脉手术后数天内，在临床诊断之前，早期识别发生 IN 的患者。
