急性胃肠损伤分级在危重病患者炎症反应中的意义

Clinical significance of acute gastrointestinal injury grades in inflammatory response of critically ill patients

目的 探讨急性胃肠损伤（AGI）分级在危重患者炎症反应中的意义.方法 2014年7月至2015年6月烟台毓璜顶医院重症医学科（ICU）收治的重症患者中随机选取AGI严重程度Ⅰ、Ⅱ、Ⅲ、Ⅳ级的患者各20例.免疫荧光法检测外周血单个核细胞核因子（NF）-κB表达;酶联免疫吸附法测定血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6水平;并测量降钙素原（PCT）、C反应蛋白（CRP）;进行统计学分析.结果 AGIⅠ级和AGIⅡ级患者NF-κB p65主要位于细胞质,AGIⅢ级患者和AGIⅣ级患者NF-κB p65主要位于细胞核,表明炎症刺激诱导了NF-κB的核移位.随着AGI分级越高,TNF-α、IL-6分泌明显升高,AGI Ⅰ -Ⅳ级患者 TNF-α分别表达为（89.76 ±19.78）ng/L、（130.54 ±23.18）ng/L、（224.65 ±39.02）ng/L、（293.17 ±36.79）ng/L,各组差异有统计学意义（P〈0.05）;IL-6分别表达为（45.96 ±9.62）ng/L、（89.26 ±12.77）ng/L、（203.71 ±58.26）ng/L、（331.18 ± 64.28）ng/L,各组差异有统计学意义（P〈0.05）.随着AGI分级越高,PCT、CRP水平明显升高,AGIⅠ~Ⅳ级患者PCT水平分别为（2.65 ±1.78）μg/L、（3.92 ±2.14）μg/L、（9.92 ±3.89）μg/L、（27.34 ± 8.45）μg/L,各组差异有统计学意义（P〈0.05）;CRP 水平分别为（13.82 ±4.93）mg/L、（32.14 ± 8.97）mg/L、（93.49 ±25.72）mg/L、（183.05 ±51.36）mg/L,各组差异有统计学意义（P〈0.05）.结论 危重患者AGI分级和炎症指标有一定的相关性,表明胃肠道功能障碍可能是引发全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）的启动因子和刺激因子.为危重患者根据AGI分级判断炎症反应程度提供了临床依据.

Objective To explore the value of acute gastrointestinal injury（AGI）grades in inflammatory response of critically ill patients.Methods Ptients with AGI severity from Ⅰ to Ⅳ were randomly selected（20 for each）from July 2014 to June 2015 in ICU of Yantai Yuhuangding Hospital.The expression of NF-κB were detected by immunofluorescence.The expression of TNF-αand IL-6 were detected by enzyme linked immunosorbent assay（ELISA）.Procalcitonin（PCT）and C reactive protein（CRP）were measured.Statistical analysis was carried out.Results For AGI grade Ⅰand AGI gradeⅡpatients,NF-κB p65 were located mainly in cytoplasm.For AGI grade Ⅲ and AGI grade Ⅳ patients, NF-κB p65 were mainly located in the nucleus,indicating that inflammatory stimulation induces nuclear translocation of NF-κB.With the higher grade of AGI, TNF-αand IL-6 secretion increased significantly.For AGI grade Ⅰ to grade Ⅳpatients, TNF-αwere expressed as（89.76 ±19.78）ng/L,（130.54 ±23.18）ng/L,（224.65 ± 39.02）ng/L,（293.17 ±36.79）ng/L,and the difference was statistically significant（P〈0.05） respectively.IL-6 were expressed as（45.96 ±9.62）ng/L,（89.26 ±12.77）ng/L,（203.71 ±58.26）ng/L, （331.18 ±64.28）ng/L,the difference was statistically significant（P〈0.05）.With the higher grade of AGI,PCT and CRP levels were significantly increased.For AGI grade Ⅰ to grade Ⅳ patients, PCT levels were（2.65 ±1.78）μg/L,（3.92 ±2.14）μg/L,（9.92 ±3.89）μg/L,（27.34 ±8.45）μg/L,and the difference was statistically significant（P〈0.05）.CRP levels were（13.82 ±4.93）mg/L,（32.14 ± 8.97）mg/L,（93.49 ±25.72）mg/L,（183.05 ±51.36）mg/L,and the difference between each group was statistically significant（P〈0.05）.Conclusions There is a certain correlation between AGI classification and inflammatory markers in critically ill patients,which shows that gastrointestinal dysfunction may be the promoter and stimulating factor in systemic inflammatory response syndrome（SIRS）and multiple organ dysfunction syndrome（MODS）.This provides a clinical basis for judging the severity of inflammatory response in critically ill patients according to AGI grades.