Tsao Tsung-Cheng, Tsai Han-Chen, Chang Shi-Chuan
From the Institute of Emergency and Critical Care Medicine, National Yang-Ming University (T-CT, S-CC) and Department of Nursing (T-CT, H-CT) and Department of Chest Medicine (S-CC), Taipei Veterans General Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2016 May;95(19):e3682. doi: 10.1097/MD.0000000000003682.
To investigate the clinical relevance of urinary fatty acid binding proteins (FABPs), including intestinal-FABP, adipocyte-FABP, liver-FABP, and heart-FABP in pneumonia patients required admission to respiratory intensive care unit (RICU).Consecutive pneumonia patients who admitted to RICU from September 2013 to October 2014 were enrolled except for those with pneumonia for more than 24 h before admission to RICU. Pneumonia patients were further divided into with and without septic shock subgroups. Twelve patients without infection were enrolled to serve as control group. Urine samples were collected on days 1 and 7 after admission to RICU for measuring FABPs and inflammatory cytokines. Clinical and laboratory data were collected and compared between pneumonia and control groups, and between the pneumonia patients with and without septic shock.There were no significant differences in urinary levels of various FABPs and inflammatory cytokines measured on day 1 between control and pneumonia groups. Urinary values of intestine-FABP (P = 0.020), adipocyte-FABP (P = 0.005), heart-FABP (P = 0.025), and interleukin-6 (P = 0.019) were significantly higher and arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2, P/F) ratio (P = 0.024) was significantly lower in pneumonia patients with septic shock on day 1 than in those without septic shock. After multivariate analysis, adipocyte-FABP was the independent factor (P = 0.026). Urinary levels of FABPs measured on day 7 of pneumonia patients were significantly lower in the improved than in nonimproved groups (P = 0.030 for intestine-FABP, P = 0.003 for adipocyte-FABP, P = 0.010 for heart-FABP, and P = 0.008 for liver-FABP, respectively). After multivariate analysis, adipocyte-FABP was the independent factor (P = 0.023).For pneumonia patients required admission to RICU, urinary levels of adipocyte-FABP on days 1 and 7 after admission to RICU may be valuable in assessing the pneumonia severity and in predicting treatment response, respectively. Further studies with larger populations are needed to verify these issues.
为了研究尿脂肪酸结合蛋白（FABPs），包括肠脂肪酸结合蛋白、脂肪细胞脂肪酸结合蛋白、肝脏脂肪酸结合蛋白和心脏脂肪酸结合蛋白在需要入住呼吸重症监护病房（RICU）的肺炎患者中的临床相关性。纳入2013年9月至2014年10月入住RICU的连续性肺炎患者，但排除入住RICU前肺炎病程超过24小时的患者。肺炎患者进一步分为有和没有感染性休克的亚组。纳入12例无感染患者作为对照组。在入住RICU后第1天和第7天采集尿样，以检测FABPs和炎性细胞因子。收集并比较肺炎组与对照组之间以及有和没有感染性休克的肺炎患者之间的临床和实验室数据。对照组和肺炎组在第1天检测的各种FABPs和炎性细胞因子的尿水平无显著差异。在第1天，有感染性休克的肺炎患者的肠脂肪酸结合蛋白（P = 0.020）、脂肪细胞脂肪酸结合蛋白（P = 0.005）、心脏脂肪酸结合蛋白（P = 0.025）和白细胞介素-6（P = 0.019）的尿值显著高于无感染性休克的患者，而动脉血氧分压/吸入氧分数（PaO2/FiO2, P/F）比值（P = 0.024）显著低于无感染性休克的患者。多因素分析后，脂肪细胞脂肪酸结合蛋白是独立因素（P = 0.026）。肺炎患者在第7天检测的FABPs尿水平在病情改善组显著低于未改善组（肠脂肪酸结合蛋白P = 0.030，脂肪细胞脂肪酸结合蛋白P = 0.003，心脏脂肪酸结合蛋白P = 0.010，肝脏脂肪酸结合蛋白P = 0.008）。多因素分析后，脂肪细胞脂肪酸结合蛋白是独立因素（P = 0.023）。对于需要入住RICU的肺炎患者，入住RICU后第1天和第7天的脂肪细胞脂肪酸结合蛋白尿水平可能分别在评估肺炎严重程度和预测治疗反应方面具有价值。需要更大样本量的进一步研究来验证这些问题。
