肠脂肪酸结合蛋白在肺炎合并胃肠功能损伤患儿血清中的变化及意义

Change in serum intestinal fatty acid binding protein and its significance in children with pneumonia and gastrointestinal injury

目的探讨肠脂肪酸结合蛋白（IFABP）在社区获得性肺炎患儿血清中的变化及与胃肠功能损伤的相关性。方法选择2015年1月至10月的社区获得性肺炎患儿82例（轻症34例,重症48例）,根据小儿危重病例评分（PCIS）将重症肺炎患儿分为非危重组（25例）和危重组（23例）;另选取体检的健康儿童30例作为对照组。采用酶联免疫吸附法检测血清IFABP浓度,并对重症肺炎患儿进行急性胃肠损伤（AGI）分级。比较各组间血清IFABP浓度的差异,并对IFABP与AGI分级和PCIS进行相关性分析。结果重症肺炎血清IFABP浓度均高于对照组和轻症肺炎组（均P〈0.01）,轻度肺炎组血清IFABP浓度亦明显高于对照组（P〈0.01）。危重组血清IFABP浓度高于非危重组（P〈0.01）。AGI 1~4级组血清IFABP均高于对照组（P〈0.01）,而且随着AGI级别的增高,血清IFABP浓度也逐渐增高,差异有统计学意义（P〈0.01）。IFABP与AGI分级呈正相关（P〈0.01）;与PCIS呈负相关（P〈0.01）。结论肺炎患儿血清IFABP均有所增高,血清IFABP可以作为肺炎患儿合并胃肠损伤早期诊断和病情评估的敏感指标。

Objective To study the change in serum intestinal fatty acid binding protein（IFABP） in children with pneumonia and its correlation with gastrointestinal injury. Methods A total of 82 children with community-acquired pneumonia who were treated from January to October, 2015 were enrolled, among whom 34 had mild pneumonia and 48 had severe pneumonia. According to pediatric critical illness score（PCIS）, the children with severe pneumonia were further divided into non-critical group（25 patients） and critical group（23 patients）. Thirty healthy children who underwent physical examination at outpatient service were enrolled as the control group. ELISA was used to measure serum IFABP level, and the acute gastrointestinal injury（AGI） grade was determined for children with severe pneumonia. Serum IFABP level was compared between groups, and the correlations of IFABP with AGI grade and PCIS were analyzed. Results The severe pneumonia group showed a significantly higher serum IFABP level than the control group and the mild pneumonia group（P〈0.01）, and the mild pneumonia group also showed a significantly higher serum IFABP level than the control group（P〈0.01）. The critical group showed a significantly higher serum IFABP level than the non-critical group（P〈0.01）. The patients with grade I-IV AGI had significantly higher serum IFABP levels than the control group（P〈0.01）, and the serum IFABP level increased significantly with the increasing AGI grade（P〈0.01）. Serum IFABP level was positively correlated with AGI grade（P〈0.01） but negatively correlated with PCIS（P〈0.01）. Conclusions Children with pneumonia experience an increased serum IFABP level which can be used as a sensitive indicator for the early diagnosis of gastrointestinal injury and the evaluation of conditions in children with pneumonia.