联合检测BT、D-LC、LDH对急性肠梗阻患者肠穿孔的预测研究

The predictive study of combined detection of BT,D-LC,and LDH on intestinal perforation in patients with acute intestinal obstruction

目的:研究联合检测细菌内毒素(BT)、D-乳酸(D-LC)、乳酸脱氢酶(LDH)对急性肠梗阻患者肠穿孔的预测价值。方法:选取2021年8月至2023年8月河北省胸科医院收治的106例急性肠梗阻患者进行回顾性研究,其中31例发生肠穿孔(肠穿孔组),75例未发生肠穿孔(无肠穿孔组),比较两组临床资料以及基线,6 h、12 h、24 h后BT、D-LC、LDH,采用受试者工作特征曲线(ROC)分析BT、D-LC、LDH对肠穿孔的预测价值。结果:肠穿孔组重度肠管损伤患者占比(100%)高于无肠穿孔组(12.00%)(P<0.05);两组6 h后BT、D-LC、LDH均呈升高趋势,12 h后无肠穿孔组BT、D-LC、LDH即开始呈降低趋势,而肠穿孔组仍呈升高趋势,24 h后BT、D-LC、LDH表现为降低趋势(P<0.05);肠穿孔组基线以及6 h、12 h、24 h后BT、D-LC、LDH均高于无肠穿孔组(P<0.05);ROC分析显示,基线以及6 h、12 h后BT、D-LC、LDH预测肠穿孔的AUC呈递增趋势,12 h后BT、D-LC、LDH预测肠穿孔的AUC最高;12 h后BT、D-LC联合LDH预测肠穿孔的AUC为0.935(95%CI:0.870~0.974),截断值0.125,敏感度为90.32%,特异度为85.33%(P<0.05)。结论:BT、D-LC、LDH与急性肠梗阻患者肠穿孔有关,且并发肠穿孔患者各指标峰值更高,持续时间更长,降低延迟,联合检测三者或可作为肠穿孔的一种预测方案,为临床诊治提供决策支持。

Objective:To study the predictive value of combined detection of bacterial endotoxins(BT),D-lactic acid(D-LC),and lactate dehydrogenase(LDH)for intestinal perforation in patients with acute intestinal obstruc-tion.Methods:A total of 106 patients with acute intestinal obstruction admitted to Hebei Chest Hospital from Au-gust 2021 to August 2023 were selected for retrospective study,including 31 patients with intestinal perforation(intestinal perforation group)and 75 patients without intestinal perforation(non-intestinal perforation group).Clinical data and BT,D-LC,LDH at baseline,after 6 h,12 h and 24 h were compared between the two groups,re-ceiver operating characteristic(ROC)curve was used to analyze the predictive value of BT,D-LC and LDH for intestinal perforation.Results:The proportion of patients with severe intestinal duct injury in the intestinal perfo-ration group(100%)was higher than that the in non-perforation group(12.00%)(P<0.05).After 6 h,BT,D-LC and LDH in both groups showed an increasing trend.After 12 h,BT,D-LC and LDH began to decrease in the non-intestinal perforation,while they still showed an increasing trend in the intestinal perforation group,and BT,D-LC and LDH showed a decreasing trend after 24 h(P<0.05).BT,D-LC and LDH in the intestinal perforation group were higher than those in the non-intestinal perforation group at baseline,after 6 h,12 h and 24 h(P<0.05).ROC analysis showed that the AUC of BT,D-LC and LDH in predicting intestinal perforation showed an increasing trend at baseline,after 6 h and after 12 h,and the AUC of BT,D-LC and LDH in predicting in-testinal perforation was the highest after 12 h.After 12 h,the AUC of intestinal perforation predicted by BT and D-LC combined with LDH was 0.935(95%CI:0.870-0.974),the cut-off value was 0.125,the sensitivity was 90.32%,and the specificity was 85.33%(P<0.05).Conclusion:BT,D-LC and LDH are correlated with intestinal perforation in patients with acute intestinal ob-struction,and patients with intestinal perforation have higher peak value of various indicators,longer duration and lower delay.Combined detection of the three indicators may be a predictive scheme for intestinal perforation to provide decision support for clinical diagnosis and treatment.