Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2024 Apr;31(4):2699-2708. doi: 10.1245/s10434-023-14857-7. Epub 2024 Jan 15.
Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied.
Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications.
A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0-142.0) to 115 pg/mL at T1 (IQR 48.0-198.0) (p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08) and anesthesia time (OR 1.13, 95% CI 1.02-1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86-260) versus 113% (IQR 44-184) respectively (p < 0.05).
A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.
由于围手术期内脏低灌注，肠壁对腔内微生物的通透性增加，这些微生物可能会进入内脏循环，从而导致并发症的发生。低灌注相关的损伤肠细胞将肠脂肪酸结合蛋白（I-FABP）释放到血浆中，I-FABP 可作为肠完整性的替代标志物。本研究通过 I-FABP 变化来检测肿瘤手术过程中肠完整性的丧失，并研究肠完整性受损与相关变量和并发症之间的关系。
纳入前瞻性队列研究中接受肿瘤手术的患者。术前（T0）和伤口关闭时（T1）采集尿液 I-FABP 样本，并在术后第 1 天（D1）和第 2 天（D2）的亚组中采集。研究 I-FABP 的动态变化，并进行逻辑回归分析，以研究 I-FABP 水平与患者相关、手术变量和并发症之间的关系。
共纳入 297 例患者，中位年龄为 70 岁。I-FABP 值中位数从 T0 时的 80.0 pg/mL（四分位距 [IQR] 38.0-142.0）增加到 T1 时的 115 pg/mL（IQR 48.0-198.0）（p < 0.05）。年龄（优势比 [OR] 1.05，95%置信区间 [CI] 1.02-1.08）和麻醉时间（OR 1.13，95%CI 1.02-1.25）与 I-FABP 增加幅度更大相关。比较发生任何并发症与无并发症的患者的 I-FABP 变化，T1 时的相对 I-FABP 变化分别为 T0 时的 145%（IQR 86-260）和 113%（IQR 44-184）（p < 0.05）。
围手术期 I-FABP 水平的显著变化表明肠完整性受损。年龄和麻醉时间与 I-FABP 增加幅度更大相关。在发生术后并发症的患者中，发现 I-FABP 增加幅度更高。
