血清二胺氧化酶在重症肺炎机械通气合并肠道屏障功能障碍患者作用的研究

The Role of Serum Diamine Oxidase on Mechanical Ventilation and Gastrointestinal Dysfunction in patients with Severe Pneumonia

目的:探讨血清二胺氧化酶(DAO)水平在重症肺炎机械通气患者中的临床意义,及其在病情评估及预后判断中的作用。方法:回顾性分析2016年10月至2017年5月在中山大学孙逸仙纪念医院重症医学科收治的重症肺炎合并呼吸衰竭机械通气患者共58例;患者在入科24小时内进行APACHEⅡ评分,并采用二胺氧化酶试剂盒(酶法)定量测定人体血清中二胺氧化酶,并分析其在与疾病严重程度及病情转归的关系。结果:重症肺炎机械通气合并肠道屏障功能障碍患者组患者血清DAO水平明显高于重症肺炎机械通气无肠道屏障功能障碍组[(18.3±13.68)U/L vs(3.8±4.10)U/L,P<0.05];重症肺炎机械通气合并肠道屏障功能障碍组患者APACHEII评分显著高于重症肺炎机械通气无肠道屏障功能障碍组[(25.03±4.85)vs(17.97±5.83),P<0.05]。重症肺炎机械通气患者中合并肠道屏障功能障碍共24例,其中死亡13例;重症肺炎机械通气无肠道屏障功能障碍患者共34例,其中死亡4例;重症肺炎机械通气合并肠道屏障功能障碍组患者28天死亡率明显高于重症肺炎机械通气无肠道屏障功能障碍组患者28天死亡率(54.17%vs 11.76%,P<0.05)。结论:血清DAO水平在重症肺炎机械通气合并肠道屏障功能障碍患者中明显升高,且与重症肺炎患者APACHEII评分及死亡率相关,监测血清DAO水平可做为评估重症肺炎机械通气患者肠道屏障功能的重要指标及疾病的严重程度的相关指标之一。

Objective：The aim of this study was to evaluate the clinical impact of serum diamine oxidase（DAO）in severe pneumonia patients with mechanical ventilation.Methods：This retrospective cohort study was conducted in de-partment of critical care medicine,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University between 1 st October 2016 and 30 th May 2017.A total of 58 mechanically ventilated patients with severe pneumonia were indentified.Among thesepatients,24（41.4%）patients were complicated with gastrointestinal dysfunction.Acute physiology and chronic healthevaluation Ⅱ（APACHE Ⅱ）was calculated and Serum DAO was detected by using diamineoxidase inspection Kit in thefirst 24 h.The correlations between serum DAO level and disease severity and prognosis were analyzed.Results：Bothserum diamine oxidase and APACHE II score in patients with severe pneumonia complicated with gastrointestinal dys-function on mechanical ventilation were significantly higher than patients without gastrointestinal dysfunction[（18.3±13.68）U/L vs.（3.8±4.10）U/L,P0.05;（25.03±4.85）vs.（17.97±5.83）,P0.05,respectively）.Patients with severe pneumonia complicated with gastrointestinal dysfunction on mechanical ventilation had a significantly higher 28-day mortality rate than those without gastrointestinal dysfunction（54.17% vs 11.76%,P0.05）.Conclusion：Serum DAO increased significantly in patients with severe pneumonia under mechanical ventilation complicated with gastrointestinal dysfunction and associated with higher APAPACHE II scores and mortality rate.DAO could be used to evaluate gastrointestinal function in severe pneumonia patients with mechanical ventilation as well as the severity of critical illness.