钝性腹部创伤合并肠损伤患者血浆I-FABP的表达水平及临床意义

Expression levels and clinical significance of plasma I-FABP in patients with blund abdominal trauma and intestinal injury

目的检测钝性腹部创伤合并肠损伤患者血浆肠脂肪酸结合蛋白(I-FABP)的表达水平,并探究其临床意义。方法 2014年7月—2017年9月苏州大学附属第一医院急诊外科收治钝性腹部创伤、疑似肠损伤患者80例,根据临床最终诊断结果,分为肠损伤组(52例)和无肠损伤组(28例),另选择30例身体健康者作为对照组。采用酶联免疫(ELISA)方法检测患者在入院时、入院后1h和3h血浆I-FABP水平,分析入院后1h血浆I-FABP水平与损伤严重程度评分(ISS)的关系及对肠损伤的诊断效能。结果 (1)与无肠损伤组比较,肠损伤组患者的ISS评分显著较高[(13. 24±2. 19)分vs.(14. 58±1. 86)分](P <0. 05);(2) ELISA检测发现,在入院时、入院后1h和3h,肠损伤组患者血浆I-FABP含量均显著高于无肠损伤组患者[(133. 86±43. 72)μg/L vs.(91. 25±38. 94)μg/L、(173. 42±56. 91)μg/L vs.(97. 65±42. 57)μg/L、(184. 89±82. 54)μg/L vs.(103. 76±41. 08)μg/L](P <0. 05);(3)肠损伤组患者经剖腹手术发现,28例(53. 85%)为单纯肠损伤,24例(46. 15%)为肠损伤合并肠系膜损伤;(4)入院后1h,血浆I-FABP蛋白表达水平与ISS评分显著呈正相关(P <0. 05);血浆I-FABP高表达对肠损伤诊断的灵敏度、特异度、准确度分别为94. 23%、78. 57%、88. 75%。结论血浆I-FABP水平在钝性腹部创伤合并肠损伤时显著升高,有望用于钝性腹部创伤所致肠损伤的早期诊断。

Objective To detect the expression level of plasma intestinal fatty acid binding protein （I-FABP） in patients with blunt abdominal trauma and intestinal injury,and to explore its clinical significance. Methods Eighty cases of blunt abdominal trauma who were suspected intestinal injury from Jul. 2014 to Sep. 2017 in the Department of Emergency Surgery of the First Affiliated Hospital of Soochow University were selected. According to the final clinical diagnosis results,they were divided into intestinal injury group （52 cases） and non intestinal injury group （28 cases）,and 30 healthy persons were selected as the control group. The plasma I-FABP level was measured by enzyme-linked immunosorbent assay （ELISA） at admission,1h after admission and 3h after admission. The relationship between plasma I-FABP level at 1h after admission and the injury severity score （ISS） and its diagnostic efficiency on intestinal injury were analyzed. Results （1） Compared with the non intestinal injury group,the ISS of the patients in intestinal injury group was significantly higher （ P 〈0.05）; （2） ELISA detection showed that plasma I-FABP levels at admission,1h after admission and 3h after admission in intestinal injury group were significantly higher than those of patients in non intestinal injury group （133.86±43.72 vs.91.25±38.94,173.42±56.91 vs. 97.65±42.57,184.89±82.54 vs.103.76±41.08）μg/L, P 〈0.05; （3）The laparotomy showed that patients with intestinal injury included 28 cases （53.85%） of simple intestinal injury and 24 cases （46.15%） of intestinal injury combined with mesenteric injury; （4） At 1h after admission,there was a significant positive correlation between plasma I-FABP protein expression level and ISS score （ P 〈0.05）. The sensitivity,specificity and accuracy of plasma I-FABP high expression in the diagnosis of intestinal injury was 94.23%,78.57%,and 88.75%,respectively. Conclusion The level of plasma I-FABP is significantly increased in blunt abdominal trauma combined with intestinal injury,and is expected to be used for the early diagnosis of intestinal injury caused by blunt abdominal trauma.