血清瓜氨酸评估严重创伤后早期急性胃肠损伤的临床价值

The value of serum citrulline in predicting the early acute gastrointestinal injury after severe trauma

目的通过测定严重创伤后患者早期不同时间点的血清瓜氨酸水平，探讨其在预测严重创伤后患者急性胃肠损伤及器官衰竭中的临床意义。方法采用前瞻性研究方法，纳入2015—08—2016—12入住兰州大学第二医院MICU严重创伤患者72例，根据创伤严重度评分（injury severity score，ISS）分为轻度创伤组（ISS〈16分）32例，简称轻伤组，重度创伤组（ISS≥16分）40例，简称重伤组。再根据2012年欧洲危重病医学会（ESICM）急性胃肠损伤（acute gastrointestinal injury，AGI）分级指南将患者分为四个亚组，即AG10组26例、AGI1组16例、AGI2组20例和AGI3组10例。选择同期兰州大学第二医院健康体检者20例作为正常对照组。收集患者临床基本资料、AGI分级，采集入院第1、3天静脉血标本，应用高效液相法测量血清瓜氨酸水平。结果重伤组、轻伤组血清瓜氨酸水平较对照组明显降低（P〈0．01或P〈0．05），且重伤组低于轻伤组（P〈0．01），第3天各亚组血清瓜氨酸水平较第1天均进一步下降（P均〈0．01）。AGI各亚组中血清瓜氨酸水平随着分级越高，其水平下降越显著（P〈0．01或P〈0．05），第3天各组血清瓜氨酸水平较第1天均进一步下降（P均〈0．01）。血清瓜氨酸水平与AGI严重程度、SOFA评分、APACHEII评分呈负相关。血清瓜氨酸≤19．07μmol／L是预测严重创伤后AGI的最佳界值。结论严重创伤后早期血清瓜氨酸水平明显降低且与创伤严重程度呈负相关，对预测创伤后早期AGI、MODS发生、发展的病理过程具有一定临床价值。

Objective To investigate the serum clinical significance of serumcitrulline level in predicting the early acute gastrointestinal injury and organ failure by measuring the level of citrulline at different time points in patients with severe trauma. Methods The 72 patients after severe trauma in MICU of the Second Hospital of Lanzhou University were studied prospectively from August 2015 to December 2016. The patients were divided into mild trauma group （ISS 〈 16 ） and severe trauma group （ISS ≥ 16） according to trauma severity score ISS,and divided into four groups, AGI 0 group, AGI 1 group, AGI 2 group, AGI 3 group according to the 2012 European Critical Care Medicine Association （ESICM） AGI classification guidelines. We selected the people for health examination as a normal control group. The basic clinical data and the grade of AGI were collected. The levels of serumcitrulline were measured by high performance liquid chromatography on day 1 and day 3. Results Compared to the normal control group, the serum citrulline levels in the minor trauma group and the severe trauma group were both reduced obviously 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 〈 0.01 ）. The serum eitndline levels in both group decreased gradually at day 3 （P 〈 0. 01 ）. The higher grade of AGI, the lower the level of serum citrulline （ P 〈 0.01 or P 〈 0.05 ） , each group of citrulline levels were further reduced at day 3 （ P 〈 0.01 ）. The level of serum citrulline was negatively correlated with AGI severity, SOFA score and APACHE Ⅱ score. Citrulline ≤ 19.07 μmol/L is the best value of predicting AGI after severe trauma. Conlusoin The decreased serum citrulline in patients with severe trauma is closely related to the severity of trauma and has a certain clinical value in predicting early AGI and MODS.