| Objective:Through measuring the levels of citrulline,I-FABP,endotoxin and PCT at different time after severe trauma,the aim of the study is to observe the degree of intestinal mucosal injury and endotoxin translocation,to to analyze the relationship between the biological markers I each other and the clinical manifestation of AGI,and to to explore the role of intestinal mucosal lesions in the pathogenesis of MODS combined with SOFA score,APACHEⅡ score.Methods:Using prospective research methods,we choose the severely traumatic patients who had hospitalized at the MICU in the Sencond Hospital of Lanzhou University during August 2015 to December 2016,and eliminated patients with gastrointestinal tract trauma,intestinal resection and chronic intestinal disease,acute and chronic kidney disease,acute and chronic kidney liver diseases.The patients who was suspected infection and the pregnant women were also eliminated.Forty-eight patients with severe trauma were divided into minor trauma(ISS<16)group and severe trauma(ISS≥16)group according to ISS and divided into AGI group and non-AGI group based on with or without AGI.AGI group were divided into three subgroups,including AGI1 group,AGI2 group,AGI3 group.We select the people who came the second hospital in Lanzhou University for healthy physical examination as a normal control group during the time of the sdudy.The basic clinical data and AGI grade were collected.The venous blood samples were collected for the measurement of citrulline,I-FABP,endotoxin and PCT on the 1st and 3rd day of admissionResults:1.Compared to the nomal control group,the citrulline levels in the minor trauma group and the severe trauma group were both reduced obviously at day 1 after trauma(P<0.01 or P<0.05),with lower level in the severe traumatic group than that in the minor trauma group(p<0.0 1).The citrulline levels in both group decreased gradually at day 3.The severe group was still significantly lower than that in the minor trauma group(P <0.01).Compared to the AGI0,AGI1 and AGI2 group,the I-FABP levels in the AGI3 group reduced obviously at day 1 after trauma(P <0.01 or P<0.05.),and which was similar in the AGI2 group compared to the AGI0 and AGI 1group(P <0.01 or P<0.05).The citrulline levels in all subgroup decreased gradually at day 3(P <0.01).The higher the grade of each subgroup,the more the decrease of citrulline levels(P <0.01 or P <0.05),and the area under the ROC curve was 0.88,the best cutoff was 19.07 umol / L,the sensitivity was 87.10%,the specificity was 76.47% for prediction of acute gastrointestinal injury after severe trauma.2.Compared to the nomal control group,the I-FABP levels in the minor trauma group and the severe trauma group were both increased obviously at day 1 after trauma(P <0.01),with higher level in the severe traumatic group than that in the minor trauma group(p<0.01).The I-FABP levels in both group decreased gradually at day 3.The severe group was still significantly higher than that in the minor trauma group(P <0.05).Compared to the AGI0,AGI1 and AGI2 group,the citrulline levels in the AGI3 group increased obviously at day 1 after trauma(P <0.01 or P<0.05),and which was similar in the AGI2 group compared to the AGI0 group(P <0.01).The I-FABp level in AGI0,AGI2 and AGI 3 group decreased gradually at day 3(p<0.01).With higher level in the AGI 2 and AGI3 group than that in the AGI 0 group((p <0.01 or p <0.05).The level of I-FABP was positively correlated with AGI severity,and the area under the ROC curve was 0.84,the best cutoff was 1657pg/ml,the sensitivity was 90.32%,the specificity was 64.71% for prediction of acute gastrointestinal injury after severe trauma.3.Compared to the nomal control group,the endotoxin levels in the minor trauma group and the severe trauma group were both increased obviously at day 1 after trauma(P <0.01),with higher level in the severe traumatic group than that in the minor trauma group(P <0.01).The endotoxin levels in both group did not change obvious at day 3(P>0.05).The severe group was still significantly higher than that in the minor trauma group(P <0.05).Compared to the AGI 0,AGI1 and AGI2 group,the endotoxin levels in the AGI3 group increased obviously at day 1 after trauma(P <0.01 or P<0.05),and which was similar in the AGI2 group compared to the AGI0 and AGI 1 group(P <0.01 or P<0.05),in the AGI1 group compared to the AGI0 group(P<0.05)The endotoxin level only in the AGI0 decreased gradually at day 3(P <0.05).With higher level in the AGI3 group than that in the AGI0 and AGI1 group((P <0.01 or P <0.05),in the AGI2 group than in the AGI1 and AGI0 group,in the AGI1 than in the AGI0.The level of endotoxin was positively correlated with AGI severity,and the area under the ROC curve was 0.90,the best cutoff was 0.234EU/ml,the sensitivity was 90.32%,the specificity was 82.35% for prediction of acute gastrointestinal injury after severe trauma.4.Compared to the nomal control group,the PCT levels in the minor trauma group and the severe trauma group were both increased obviously at day 1 after trauma(P <0.01 or P<0.05).The endotoxin levels in both group did not change obvious at day 3(P>0.05).The severe group was still significantly higher than that in the minor trauma group(P <0.05).Compared to the AGI0,AGI1 and AG2 group,the PCT levels only in the AGI3 group increased obviously at day 1 after trauma(P <0.01).The pCT level among all group did not change obvious at day 3(P>0.05).With higher level in the AGI3 group than that in the AGI0 and AGI1 group((P <0.01 or P <0.05),in the AGI2 group than in the AGI0 group.The level of PCT was positively correlated with AGI severity.5.There was a significant negative correlation between the level of citrulline and the levels of I-FABP,endotoxin,PCT,APACHEⅡ score and SOFA score on day 1,day 3.The levels of I-FABP,endotoxin,PCT,APACHEⅡ score,SOFA scores were positively correlated with each other on day 1,day 3.The same result is obtained by combining the indicators of day 1and day 3.The level of I-FABP in the operation group was significantly higher than that in the non-operation group at 72 hours after admission.Conlusion:The levels of citrulline,I-FABP,endotoxin and PCT were significantly increased in the early stage of trauma,and the changes of the levels were positively correlated to the severity of trauma and the severity of AGI,which of citrulline showed the opposite change.There was a significant negative correlation between APACHEII score and SOFA score and the level of citrulline,and which was positive between APACHEⅡ score and SOFA score and the levels of I-FABP,endotoxin,PCT.The levels of citrulline,I-FABP,endotoxin,PCT,were positively correlated with each other.Citrulline,I-FABP endotoxin levels can be used as a potential biomarker for predicting early AGI in patients with severe trauma. |
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