Blaser Annika, Padar Martin, Tang Jonathan, Dutton John, Forbes Alastair
Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
Anaesthesiol Intensive Ther. 2019;51(3):230-239. doi: 10.5114/ait.2019.86049.
Currently there is no reliable tool available to monitor gastrointestinal function in the critically ill. Biomarkers are therefore of great interest in this field as the lack of monitoring tools impedes any interventional studies. The potential biomarkers citrulline and intestinal fatty acid-binding protein (I-FABP) are the present focus. Targeted literature searches were undertaken for physiology and pathophysiology, sampling, measurement methods and clinical use of citrulline and I-FABP as biomarkers of intestinal function and injury. Physiology and pathophysiology, specific aspects of sampling and different laboratory assays are summarized and respective pitfalls outlined. Studies in animals and patients outside the ICU support the rationale for these biomarkers. At the same time, evidence in critically ill patients is not yet convincing, several specific aspects need to be clarified, and methodology and interpretation to be refined. We conclude that there are good physiological rationales for citrulline as a marker of enterocyte function and for I-FABP as a marker of intestinal injury, but further studies are needed to clarify whether and how they could be used in daily practice in caring for critically ill patients.
目前，尚无可靠的工具可用于监测危重症患者的胃肠功能。因此，生物标志物在该领域备受关注，因为监测工具的缺乏阻碍了任何干预性研究。潜在的生物标志物瓜氨酸和肠脂肪酸结合蛋白（I-FABP）是当前的研究重点。针对瓜氨酸和I-FABP作为肠功能和损伤生物标志物的生理学和病理生理学、采样、测量方法及临床应用进行了有针对性的文献检索。总结了生理学和病理生理学、采样的具体方面以及不同的实验室检测方法，并概述了各自的缺陷。ICU以外的动物和患者研究支持了这些生物标志物的理论依据。与此同时，危重症患者的证据尚不令人信服，一些具体方面需要阐明，方法和解释也有待完善。我们得出结论，瓜氨酸作为肠上皮细胞功能标志物以及I-FABP作为肠损伤标志物有充分的生理学依据，但需要进一步研究以明确它们是否以及如何应用于危重症患者的日常护理中。
