Zhu Chengrui, Ding Renyu, Sun Yini, Ma Xiaochun
Department of Critical Care Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China. Corresponding author: Ma Xiaochun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Jun;26(6):420-4. doi: 10.3760/cma.j.issn.2095-4352.2014.06.011.
To investigate the content of intestinal fatty acid binding protein (IFABP) and its clinical significance in patients with severe sepsis.
A prospective observational study was conducted. Fifty patients with severe sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from July to December 2012 were enrolled, and 20 healthy patients served as control group. The concentrations of serum IFABP, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were determined with enzyme-linked immunosorbent assay (ELISA) on days 0, 1 and 3 after ICU admission. Acute physiology and chronic health evaluation II (APACHEII) and sequential organ failure assessment (SOFA) score, 28-day prognosis, acute gastrointestinal injury (AGI) grade were recorded at the same time. Furthermore, the contents of IFABP were compared between control group and the severe sepsis group, abdominal infection group and non-abdominal infection group, the survival group and the death group, as well as among different AGI-grade groups. Correlation analysis of IFABP and inflammatory factors, IFABP and two scores, and IFABP and time of stay in ICU and mechanical ventilation were studied. Multivariate logistic regression and analysis of 28-day outcome of the patients were also studied.
IFABP levels were increased in severe sepsis patients on days 0, 1 and 3 compared with those of healthy control group (731.90±53.91 mg/L, 592.07 ± 41.94 mg/L, 511.85 ± 47.97 mg/L vs. 439.88 ± 23.68 mg/L, all P=0.000). There was no statistical significance of IFABP levels between abdominal infection group and non-abdominal infection group, the survival group and the death group, or among different AGI-grade groups. The correlation analysis showed that IFABP was statistically related with IL-6 (r=0.794, P=0.000), TNF-α (r=0.878, P=0.010), APACHEII score (r=0.428, P=0.000) in patients with severe sepsis. Significant correlations were also found between IFABP and IL-6 (r=0.812, P=0.000), TNF-α (r=0.885, P=0.000) in abdominal infection group, as well as in non-abdominal infection group (IL-6: r=0.739, P=0.000; TNF-α: r=0.828, P=0.000). As shown by multivariate logistic regression analysis, SOFA scores on days 0, 1, 3 were the independent risk factors for death [odds ratio (OR) was 1.624 (P=0.004), 1.411 (P=0.027), 1.740 (P=0.012), respectively], but IFABP level, AGI grade, and APACHEII score had no influence on death rate.
IFABP concentrations in patients with severe sepsis were significantly increased, and it is correlated well to IL-6, TNF-α and APACHEII score, but did not related obviously with AGI grade and the prognosis of the patients.
探讨严重脓毒症患者肠道脂肪酸结合蛋白（IFABP）的含量及其临床意义。
进行一项前瞻性观察研究。选取2012年7月至12月在中国医科大学附属第一医院重症监护病房（ICU）收治的50例严重脓毒症患者，另选20例健康患者作为对照组。于入住ICU后第0、1、3天采用酶联免疫吸附测定（ELISA）法测定血清IFABP、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的浓度。同时记录急性生理与慢性健康状况评分系统II（APACHEII）和序贯器官衰竭评估（SOFA）评分、28天预后、急性胃肠损伤（AGI）分级。此外，比较对照组与严重脓毒症组、腹部感染组与非腹部感染组、存活组与死亡组之间以及不同AGI分级组之间IFABP的含量。研究IFABP与炎症因子、IFABP与两项评分以及IFABP与ICU住院时间和机械通气时间的相关性分析。还研究了多因素logistic回归及患者28天结局分析。
与健康对照组相比，严重脓毒症患者在第0、1、3天的IFABP水平升高（731.90±53.91mg/L、592.07±41.94mg/L、5l1.85±47.97mg/L 对比 439.88±23.68mg/L，P均=0.000）。腹部感染组与非腹部感染组、存活组与死亡组之间以及不同AGI分级组之间IFABP水平差异均无统计学意义。相关性分析显示，严重脓毒症患者中IFABP与IL-6（r=0.794，P=0.000）、TNF-α（r=0.878，P=0.oo0）、APACHEII评分（r=0.428，P=0.000）具有统计学相关性。在腹部感染组以及非腹部感染组中，IFABP与IL-6（腹部感染组：r=0.812，P=0.000；非腹部感染组：r=0.739，P=0.000）、TNF-α（腹部感染组：r=0.885，P=0.000；非腹部感染组：r=0.828，P=0.000）之间也存在显著相关性。多因素logistic回归分析显示，第0、1、3天的SOFA评分是死亡的独立危险因素[比值比（OR）分别为1.624（P=0.004）、1.411（P=0.o27）、1.740（P=0.012）]，而IFABP水平、AGI分级和APACHEII评分对死亡率无影响。
严重脓毒症患者的IFABP浓度显著升高，且与IL-6、TNF-α及APACHEII评分具有良好的相关性，但与AGI分级及患者预后无明显相关性。
