Osuka Akinori, Kusuki Hirofumi, Matsuura Hiroshi, Shimizu Kentaro, Ogura Hiroshi, Ueyama Masashi
Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Clinical Laboratory, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
Burns. 2017 Jun;43(4):824-829. doi: 10.1016/j.burns.2016.10.015. Epub 2016 Dec 28.
Severely burned patients occasionally suffer intestinal ischemia leading to a fatal outcome, and the gut is considered a "motor" driving the development of multiple organ failure. However, in clinical settings, it has been difficult to assess acute intestinal damage following burn and its consequence to patient outcome. Intestinal fatty acid binding protein (I-FABP) is a known biomarker for diagnosing intestinal ischemia/damage. This study aimed to assess the extent of intestinal damage using serial I-FABP measurements following severe burn and to clarify the association between intestinal damage and the development of organ dysfunctions.
Patients aged >15years old who suffered burn over 20% total body surface area (TBSA) were enrolled in this prospective cohort study. Patients with cardiac arrest on admission or who were transferred >24h after injury were excluded. Patients with chemical burn were also excluded. Burn size and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were recorded at the time of patient enrollment. I-FABP was measured on admission and at 1, 4, 7, 14, and 30days following injury. Other biomarkers such as lactate, lactate dehydrogenase (LDH), creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase, amylase, and creatinine (Cre) were also measured at the same time points as I-FABP. We also evaluated the serial change in Sequential Organ Failure Assessment (SOFA) score.
The study included 32 patients. Serum I-FABP level on the day of admission was significantly increased in the patients compared with healthy controls. Increased I-FABP levels were normalized at 4days after injury. The serum level of I-FABP on the day of admission correlated with %TBSA (III) and APACHE II score. A high I-FABP level on admission was associated with the subsequent development of multiple organ dysfunction. The increase in I-FABP level also correlated with increases of AST, LDH, and CK levels.
Serum level of I-FABP on admission day does not correlate with burn size, but with the deep burn area. The gut might be a crucial target organ following severe burn, and gut damage could have an important role in the development of multiple organ dysfunction.
严重烧伤患者偶尔会发生肠道缺血，导致致命后果，肠道被认为是驱动多器官功能衰竭发展的“发动机”。然而，在临床环境中，评估烧伤后急性肠道损伤及其对患者预后的影响一直很困难。肠道脂肪酸结合蛋白（I-FABP）是诊断肠道缺血/损伤的一种已知生物标志物。本研究旨在通过严重烧伤后连续测量I-FABP来评估肠道损伤程度，并阐明肠道损伤与器官功能障碍发展之间的关联。
纳入年龄大于15岁、烧伤总面积超过20%（TBSA）的患者进行这项前瞻性队列研究。排除入院时心脏骤停或受伤后超过24小时才转诊的患者。化学烧伤患者也被排除。在患者入组时记录烧伤面积和急性生理与慢性健康状况评分II（APACHE II）。在入院时以及受伤后1、4、7、14和30天测量I-FABP。其他生物标志物，如乳酸、乳酸脱氢酶（LDH）、肌酸激酶（CK）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶、淀粉酶和肌酐（Cre）也在与I-FABP相同的时间点进行测量。我们还评估了序贯器官衰竭评估（SOFA）评分的连续变化。
该研究纳入了32例患者。与健康对照组相比，患者入院当天血清I-FABP水平显著升高。受伤后4天I-FABP升高水平恢复正常。入院当天I-FABP血清水平与TBSA（III）和APACHE II评分相关。入院时I-FABP水平高与随后多器官功能障碍的发生有关。I-FABP水平的升高也与AST、LDH和CK水平的升高相关。
入院当天血清I-FABP水平与烧伤面积无关，而与深度烧伤面积有关。肠道可能是严重烧伤后的关键靶器官，肠道损伤可能在多器官功能障碍的发展中起重要作用。
