血清L-乳酸、D-乳酸、肌酸激酶和I-FABP能否用作疑似肠道缺血的危重症患者的诊断标志物？
Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia.
作者信息
van der Voort Peter H J, Westra Berit, Wester Jos P J, Bosman Rob J, van Stijn Ilse, Haagen Inez-Anne, Loupatty Ference J, Rijkenberg Saskia
机构信息
Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands ; TIAS business school of Tilburg University, Tilburg, The Netherlands.
Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
出版信息
BMC Anesthesiol. 2014 Dec 2;14:111. doi: 10.1186/1471-2253-14-111. eCollection 2014.
BACKGROUND
The prognostic value of biochemical tests in critically ill patients with multiple organ failure and suspected bowel ischemia is unknown.
METHODS
In a prospective observational cohort study intensive care patients were included when the attending intensivist considered intestinal ischemia in the diagnostic workup at any time during intensive care stay. Patients were only included once. When enrolment was ended each patient was classified as 'proven intestinal ischemia', 'ischemia likely', 'ischemia unlikely' or 'no intestinal ischemia'. Proven intestinal ischemia was defined as the gross disturbance of blood flow in the bowel, regardless of extent and grade. Classification was based on reports from the operating surgeon, pathology department, endoscopy reports and CT-scan. Lactate dehydrogenase (LDH), creatine kinase (CK), alanine aminotransferase (ALAT), L-lactate were available for the attending physician. D-lactate and intestinal fatty acid binding protein (I-FABP) were analysed later in a batch. I-FABP was only measured in patients with proven ischemia or no ischemia.
RESULTS
For 44 of the 120 included patients definite diagnostic studies were available. 23/44 patients (52%) had proven intestinal ischemia as confirmed by surgery, colonoscopy, autopsy and/or histopathological findings. LDH in these patients was 285 U/l (217-785) vs 287 U/l (189-836) in no-ischemia; p = 0.72. CK was 226 U/l in patients with proven ischemia (126-2145) vs 347 U/l (50-1427), p = 0.88. ALAT was 53 U/l (18-300) vs 34 U/l (14-34), p-0,56. D-lactate 0.41 mmol/l (0.11-0.75) vs 0.56 mmol/l (0.27-0.77), p = 0.46. L-lactate 3.5 mmol/l (2.2-8.4) vs 2.6 mmol/l (1.7-3.9), p = 0.09. I-FABP 2872 pg/ml (229-4340) vs 1020 pg/ml (239-5324), p = 0.98. Patient groups proven and likely ischemia together compared to unlikely and no-ischemia together showed significant higher L-lactate (p = 0.001) and higher D-lactate (p = 0.003).
CONCLUSIONS
Measurement of LDH, CK, and ALAT did not discriminate critically ill patients with proven intestinal ischemia from those with definite diagnosis no-ischemia. However, L-lactate and D-lactate levels were higher in patients with proven or likely ischemia and need further study just as I-FABP.
背景
生化检测对多器官功能衰竭且疑似肠道缺血的重症患者的预后价值尚不清楚。
方法
在一项前瞻性观察队列研究中，当主治重症监护医生在重症监护期间的任何时间将肠道缺血纳入诊断检查时，纳入重症监护患者。患者仅纳入一次。入组结束后，将每位患者分类为“确诊肠道缺血”、“可能缺血”、“不太可能缺血”或“无肠道缺血”。确诊肠道缺血定义为肠道血流严重紊乱，无论范围和程度如何。分类基于手术医生报告、病理科报告、内镜检查报告和CT扫描。主治医生可获取乳酸脱氢酶（LDH）、肌酸激酶（CK）、谷丙转氨酶（ALAT）、L-乳酸水平。D-乳酸和肠脂肪酸结合蛋白（I-FABP）随后进行批量分析。I-FABP仅在确诊缺血或无缺血的患者中测量。
结果
120例纳入患者中的44例有明确的诊断研究。23/44例患者（52%）经手术、结肠镜检查、尸检和/或组织病理学检查确诊为肠道缺血。这些患者的LDH为285 U/l（217 - 785），无缺血患者为287 U/l（189 - 836）；p = 0.72。确诊缺血患者的CK为226 U/l（126 - 2145），而无缺血患者为347 U/l（50 - 1427），p = 0.88。ALAT为53 U/l（18 - 300），无缺血患者为34 U/l（14 - 34），p = 0.56。D-乳酸为0.41 mmol/l（0.11 - 0.75），无缺血患者为0.56 mmol/l（0.27 - 0.77），p = 0.46。L-乳酸为3.5 mmol/l（2.2 - 8.4），无缺血患者为2.6 mmol/l（1.7 - 3.9），p = 0.09。I-FABP为2872 pg/ml（229 - 4340），无缺血患者为1020 pg/ml（239 - 5324），p = 0.98。与不太可能缺血和无缺血的患者组相比，确诊和可能缺血的患者组一起显示L-乳酸显著更高（p = 0.001）和D-乳酸更高（p = 0.003）。
结论
LDH、CK和ALAT的测量不能区分确诊肠道缺血的重症患者和明确诊断无缺血的患者。然而，确诊或可能缺血患者的L-乳酸和D-乳酸水平较高，I-FABP也需要进一步研究。
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