瓜氨酸和肠型脂肪酸结合蛋白检测在重症患儿急性胃肠损伤诊断中的临床价值

Detection significance of citrulline and enteric fatty acid binding protein in acute gastrointestinal injury of severe children

目的探讨瓜氨酸和肠型脂肪酸结合蛋白(IFABP)检测在重症患儿急性胃肠损伤(AGI)诊断中的临床价值。方法前瞻性选取西南医科大附属中医院2015年5月至2017年5月收治的重症患儿60例,根据合并AGI情况将其分为合并组(n=30)和未合并组(n=30)两组。运用高效液相色谱法检测两组患儿的血清瓜氨酸水平,运用酶联免疫吸附法(ELISA)检测两组患儿的血清IFABP水平,然后对两组患儿的血清瓜氨酸、IFABP、C反应蛋白(CRP)、降钙素原(PCT)水平,瓜氨酸、IFABP与CRP、PCT的相关性,儿童危重症AGI诊断中瓜氨酸、IFABP单独及联合检测的价值进行统计分析。结果合并组患儿的血清瓜氨酸水平显著低于未合并组(P<0.05),血清IFABP、CRP、PCT水平均显著高于未合并组(P<0.05);瓜氨酸与CRP、PCT均呈显著的负相关关系(r=-0.660,-0.708,P<0.05),但IFABP与CRP、PCT均无相关性(r=0.107,0.200,P>0.05);儿童危重症AGI诊断中瓜氨酸+IFABP检测的敏感度、特异度、准确度96.7%、93.3%、95.0%均显著高于瓜氨酸、IFABP 83.3%、80.0%、81.7%和80.0%、76.7%、78.3%(P<0.05),但瓜氨酸、IFABP检测的敏感度、特异度、准确度83.3%、80.0%、81.7%比80.0%、76.7%、78.3%之间的差异均无显著性(P>0.05)。结论瓜氨酸和肠型脂肪酸结合蛋白在重症患儿急性胃肠损伤中表达异常,联合两者检测对重症患儿急性胃肠损伤的诊断具有较高的价值,值得在临床推广应用。

Objective To investigate the detection significance of citrulline and enteric fatty acid binding protein in acute gastrointestinal injury of severe children. Methods 60 cases of severe children from May 2015 to May 2017 in our hospital were randomly selected,these children were divided into combined group（ n = 30） and not combined group（ n = 30） by random series of tables generated by a computer,the serum citrulline levels of the two groups were detected by high performance liquid chromatography,and the serum IFABP levels of the two groups was detected by enzyme-linked immunosorbent assay（ ELISA）,then the serum citrulline,IFABP,CRP,PCT levels of the two groups,correlations of citrulline,IFABP and CRP,PCT,alone and combination values of citrulline,IFABP in the diagnosis of critically ill AGI children were statistically analyzed. Results The serum citrulline level of the combined group was significantly lower than the not combined group（ P〈0. 05）,the serum IFABP,CRP and PCT levels were significantly higher than the not combined group（ P〈0. 05）. Citrulline and CRP,PCT were significantly negatively correlated（ r =-0. 660,r =-0. 708,P〈0. 05）,but there were no significant correlations between IFABP and CRP and PCT（ r =0. 107,r = 0. 200,P〉0. 05）. The detection sensitivity and specificity and accuracy of citrulline ＋ IFABP in the diagnosis of critically ill AGI children 96. 7%,93. 3%,95. 0% were significantly higher than citrulline,IFABP 83. 3 %,80. 0 %,81. 7 % and 80. 0 %,76. 7 %,78. 3 %（ P〈0. 05）,but the differences of sensitivity,specificity and accuracy between CCP,IFABP 83. 3%,80. 0%,81. 7% vs. 80. 0%,76. 7%,78. 3% were not significant（ P〉0. 05）. Conclusion Combined detection of citrulline and intestinal fatty acid binding protein has higher value in the diagnosis of acute gastrointestinal injury of critically ill children,so it is worthy of clinical promotion and application.