危重症胃肠功能衰竭时两种胃肠激素水平变化的研究

Study on the changes of blood gastrin and glucagon in critically-ill patients with gastrointestinal function failure

目的:探讨危重症患者血胃泌素、胰高血糖素的变化及其与胃肠功能衰竭的关系。方法:对急诊科和ICU就诊住院的危重症患者30例和30例正常健康人,应用发射免疫分析法测定其血胃泌素、胰高血糖素水平并作比较。结果:(1)危重症患者危重期的血胃泌素、胰高血糖素水平[(2.62±0.43)ng/L、(3.3±0.5)ng/L]均较恢复期[(2.47±0.51)ng/L、(2.9±0.6)ng/L]和正常组[(2.19±0.73)ng/L、(2.9±0.4)ng/L]明显升高(P<0.01);恢复期与正常组比较无统计学差异(P>0.05);(2)伴胃肠功能衰竭的危重症患者血胃泌素、胰高血糖素水平[(2.67±0.51)ng/L、(3.4±0.5)ng/L]显著高于正常组[(2.19±0.73)ng/L、(2.9±0.4)ng/L](P<0.05),有胃肠功能衰竭患者血胃泌素、胰高血糖素水平有高于不伴有胃肠功能衰竭者[(2.55±0.28)ng/L、(3.1±0.5)ng/L]的趋向,但无统计学差异(P>0.05);(3)多器官损害组胃泌素、胰高血糖素水平[(2.66±0.47)ng/L、(3.4±0.5)ng/L]高于单器官损害组[(2.53±0.28)ng/L、(2.9±0.5)ng/L],其中胰高血糖素水平增高有统计学差异(P<0.05);⑷危重症患者胃泌素、胰高血糖素水平均呈正相关(危重症组r=0.443,P<0.05,对照组r=0.832,P<0.01)。结论:危重症患者胃泌素、胰高血糖素水平与病情及胃肠功能衰竭密切相关,检测血浆胃泌素、胰高血糖素水平可作为反映危重患者病情及评估预后的一个参考指标。

Objective： To study the significance of changes in blood gastrin（GAS） and glucagon（GLU） and their relationship with gastrointestinal function failure in critically-ill patients.Methods： The study included 30 patients with critical illness and 30 healthy people（control group）.The concentration of blood GAS and GLU was determined by using radioimmunoassay（RLA） and was compared between the two groups.Results：（1） During high risk period,the GAS（2.62±0.43） ng/L and GLU（3.3±0.5） ng/L concentration in critical-ill patients was significant higher than the demonstrated level when they were in recovery period [GAS（2.47±0.51）ng/L,GLU（2.9±0.6） ng/L] or that of the control group [GAS（2.19±0.73） ng/L,GLU（2.9±0.4） ng/L ] but no significant difference was found between the two groups when the critical-ill patients were in recovery period.（2）Blood GAS（2.67±0.51） ng/L and GLU（3.4±0.5） ng/L levels were significantly higher in critically-ill patients complicated with gastrointestinal function failure than that in control group [GAS（2.19±0.73） ng/L,GLU（2.9±0.4） ng/L]（P〈0.05）.There was a more obvious trend of higher GAS and GLU levels being observedin the critically-ill patients complicated with gastrointestinal function failure [GAS（2.67±0.51） ng/L and GLU（3.4±0.5） ng/L ] than that in patients without gastrointestinal function failure[GAS（2.55±0.28） ng/L,GLU（3.1±0.5） ng/L],but the difference was not statistically significant（P〉0.05）.（3）Levels of GAS（2.66±0.47） ng/L and GLU（3.4±0.5） ng/L were significantly higher in group with multiple organ failure than those with single organ failure [GAS（2.53±0.28） ng/L、GLU（2.9±0.5） ng/L]（P〈0.05）.（4）There was a positive correlation between the levels of GAS and GLU both in patients and in control group（r=0.443 in patient group,P〈0.05,r=0.832 in control group,P〈0.01）.Conclusion： The levels of GAS and GLU in critical illness is closely associated with disease development and gastrointestinal function failure.Blood GAS and GLU can be used for predicting disease severity and prognosis in critically-ill patients.