应用血清肠脂肪酸结合蛋白和D-乳酸评估神经外科重症患者肠道损伤的临床研究

目的探讨血清肠脂肪酸结合蛋白（I-FABP）与D-乳酸（D-LA）在评估神经外科重症患者肠道损伤中的临床价值。方法回顾性分析2018年1月—2020年1月玉林市第一人民医院神经外科收治的80例重症患者临床资料，根据患者是否合并肠道损伤，将38例合并肠道损伤的患者设置为肠伤组，将42例单纯性神经外科重症患者设置为无肠伤组。对比两组患者入院第1天、第3天时的白蛋白（PA）、铜蓝蛋白（CP）、运铁蛋白（TF）、I-FABP、D-LA、总蛋白（TP）、D-二聚体（D-D）、C反应蛋白（CRP）水平及急性生理与慢性健康评分-Ⅱ（APACHE-Ⅱ），并分析I-FABP、D-LA水平与PA、CP、TF、TP、D-D、CRP的相关性。结果两组入院后第1天的PA、CP、TF、TP、D-D、CRP、I-FABP、D-LA水平及APACHE-Ⅱ评分以及入院第3天的D-D、CRP水平对比差异均无统计学意义（P＞0.05）；入院第3天肠伤组PA、CP、TF、TP低于无肠伤组（t=7.630、2.712、5.701、5.574，P＜0.05），I-FABP、D-LA、APACHE-Ⅱ高于无肠伤组（t=18.481、26.924、5.037，P＜0.05）；相关分析结果显示，I-FABP、D-LA水平与D-D、CRP间无显著相关性（r=0.143、0.182，P＞0.05），而与APACHE-Ⅱ呈正相关（r=0.386，P＜0.05），与PA、CP、TF、TP呈负相关（r=-0.531、-0.742、-0.673、-0.802，P＜0.05）。结论神经外科重症患者出现肠道损伤时血清中I-FABP、D-LA的表达水平会显著升高，且I-FABP、D-LA水平与患者危重程度存在关联。

Objective To investigate the clinical value of serum intestinal fatty acid binding protein(I-FABP) and D-lactic acid(D-LA) in the evaluation of intestinal injury in severe neurosurgical patients. Methods The clinical data of 80 severe patients admitted to Department of Neurosurgery, The First People’s Hospital of Yulin from January 2018 to January 2020 were analyzed retrospectively. According to whether the patients were complicated with intestinal injury, 38 patients with intestinal injury were set as intestinal injury group, and 42 patients with simple severe neurosurgery were set as no intestinal injury group. The levels of albumin(PA), ceruloplasmin(CP), transferrin(TF), I-FABP, D-LA, total protein(TP), D-Dimer(D-D), C-reactive protein(CRP) and acute physiology and chronic health score Ⅱ(APACHE-Ⅱ) on the first day and the third day after admission were compared between the two groups, and the correlation between I-FABP, D-LA and PA, CP, TF, TP, D-D, CRP was analyzed. Results There were no statistically significant differences in the PA, CP, TF, TP, DD, CRP, I-FABP, D-LA levels and APACHE-Ⅱ scores between the two groups on the first day after admission, and the levels of DD and CRP on the third day after admission(P＞0.05). PA, CP, TF, TP of the intestinal injury group on the 3rd day of admission were lower than those of the non-intestinal injury group(t=7.630,2.712,5.701,5.574,P＜0.05). I-FABP, D-LA, APACHE-Ⅱ were higher than the group without intestinal injury(t=18.481,26.924,5.037,P<0.05). The results of correlation analysis showed that there was no significant correlation between the levels of I-FABP, D-LA and DD, CRP(r=0.143,0.182,P＞0.05), and positively correlated with APACHE-Ⅱ(r=0.386,P＜0.05), and negatively correlated with PA, CP, TF, TP(r=-0.531,-0.742,-0.673,-0.802,P＜0.05). Conclusion The expression levels of I-FABP and D-LA in serum of severe neurosurgical patients with intestinal injury are significantly increased, and the levels of I-FABP and D-LA are associated with the severity of patients.