| objective:To evaluate the diagnostic value of a-GST,DAO,D-lactate,citrullin e and I-FABP in the evaluation of intestinal barrier dysfunction in critically ill patients.Methods:Thirty healthy volunteers and 39 surgical patients(contains 20 patients with radical gastrectomy,5 patients with pancreaticoduodenectomy,7 patients w ith radical cholangiocarcinoma,7 patients with hemihepatectomy)were enrolled in this study.The concentration of healthy volunteers of these indicators as to establish the normal range of indicators;Compared patients with preoperative and postoperative changes in the indicators and take a Logistic Regression and ROC Curve Analysis of Functional with intestinal barrier.Results:1,The concentration of serum ?-GST,DAO,D-lactate,citrulline and I-FABPThe normal range of indicators:?-GST:4.95±1.63ng/ml;DAO:7.48±4.92 mIU/ml;D-lactate:0.42±0.14 nmol/ul;citrulline:138.46±19.78 umol/ml;I-FABP:46.90±3.35pg/ml;There was no significant difference in D-lactate,citrulline and I-FABP bet ween normal volunteers and patients before operation(P>0.05).The concentrat ion of serum a-GST,DAO was significant difference between normal volunteer s and patients presurhical(P<0.05)All of the indicators was changed,citrulline after surgery showed a down ward trend and the others showed a downward trend.2,Subgroup analysis:The detection of indicators according to the type of dise ase divided into 4 groups(gastrointestinal tumor radical surgery group,hemihe patic resection group,high radical cholangiocarcinoma group and pancreaticodu odenectomy group),There was no significant difference between the indexes all above.(All indicators of P value were>0.05)3,Escherichia coli 16SRNA real-time quantitative PCR(16SDNAqPCR)resultsThe expression of Escherichia coli 16S DNAqPCR in peripheral blood of 14 patients was significantly higher than that before operation(t =-2.180,P =0.048).In the other 25 patients was no significantly change after operation(t?0.00,P = 1.0).4,Intestinal barrier dysfunction by clinical evaluationThere were 12 cases regarded as intestinal barrier dysfunction and 27 case s were not,them were divided into two groups according to the criteria of int estinal barrier dysfunction.5,The concentration of serum I-FABP and D-lactate were significantly higher than those in patients which estimated by the clinical evaluation as intestinal barrier dysfunction(P<0.05).The levels of citrulline was lower in the patients with intestinal barrier dysfunction.6,The diagnosis value of indicatorsThe results showed that the AUC of serum a-GST,DAO,D-lactate,citru Iline and I-FABP were 0.636(P<0.05)(P=0.391),0.522(P=0.831),0.71(P=0.039),0.713(P=0.036)and 0.815(P=0.002),and the ROC curve was used to obtain.The optimal cutoff values of DAO,D-lactate,citrulline and I-F ABP were 12.71ng/ml,16.62mIU/ml,1.17nmol/ul,96.74umol/ml and 104.13pg/ml respectively.The regression equation was:y =-0.043xi-0.115x2 + 3.923x3-0.019x4 + 0.018x5(where:x1 represents ?-GST;x2 represents DAO;x3 represents D-lactate;x4 represents citrulline;xs represents I-FABP);further studies of ROC curves show that the five indicators jointly predict AUC = 0.846 for intestinal barrier dysfunction,the diagnostic efficacy better than any single assessment index;Thr ee kinds of indicators were used to exclude ?-GST and DAO.(1:xi for D-la ctate;x2 for citrulline;x3 for I-FABP)Further ROC curve analysis showed that the three test indicators were combined to predict the regression equation:y=3.100x1-0.030x2+0.012x3 Intestinal barrier dysfunction AUC = 0.849.Compared with the five diagnostic indicators combined and the three diagn ostic indicators combined that the area under the curve of the two close,the d ifference was not statistically significant.(P=0.034).7,The clinical outcome of patients and postoperative complicationsAll patients were discharged smoothly,none died,2 patients had pulmonar y infection and 1 patient had abdominal infection.The incidence of postoperati ve infection was 7.6%(3/39).The total incidence of postoperative SIRS was 53.8%(21/39).The incidence of postoperative SIRS was 100%(12/12)in all pa tients diagnosed with intestinal barrier dysfunction,whereas the incidence of po stoperative SIRS in patients with intestinal barrier dysfunction was:33.33%(9/27).8,The diagnostic indicators in the clinical assessment of patients without intest inal barrier dysfunction in the expression of differencesAccording to the clinical evaluation criteria,there were still some postoper ative SIRS in patients who were considered to have no intestinal barrier dysfu notion after surgery.The incidence was as follows:33.33%(9/27).(P<0.05).The other indexes were not significantly different between the two groups(P>0.05).The results showed that there was no significant difference between the two groups(P>0.05)Conclusion:Serum ?-GST,DAO,D-lactate,citrulline and I-FABP are effective f or predicting intestinal barrier dysfunction in critically ill patients.The predictiv e efficacy of the combination of various indicators is superior to any single tes t index.Among them,the serum concentration of I-FABP,citrulline and D-lacti c acid as the combined predictive index of intestinal barrier dysfunction is reli able,The combined effect of the indicators is equivalent. |
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