不同疾病进展及预后的脓毒症患者肠道屏障功能指标变化研究

Changes of intestinal barrier function indicators in sepsis patients with different disease progression and prognosis

目的 分析不同疾病进展及预后的脓毒症患者肠道屏障功能指标变化。方法 选择脓毒症患者454例为研究对象,根据疾病严重程度分为脓毒血症组(153例)、严重脓毒血症组(189例)、脓毒性休克组(112例),回顾性收集患者临床资料。比较3组肠道屏障功能指标及炎症指标、疾病进展评分,通过Pearson相关性分析法分析肠道屏障功能指标、炎症指标与疾病进展评分的相关性。结果 脓毒血症组、严重脓毒血症组、脓毒性休克组全血白细胞计数(WBC)、血清二胺氧化酶(DAO)、D-乳酸、降钙素原(PCT)、血清瓜氨酸化组蛋白H3(CITH3)水平、急性生理学和慢性健康状况评分(APACHEⅡ)和序贯器官衰竭评分(SOFA)评分呈上升趋势,且组间比较差异具有统计学意义(P <0.05)。严重脓毒血症组、脓毒性休克组血清内毒素水平高于脓毒血症组(P <0.05)。死亡组全血WBC、血浆DAO、D-乳酸、PCT、血清CITH3、内毒素水平、APACHEⅡ、SOFA评分高于存活组(P <0.05)。APACHEⅡ、SOFA评分与全血WBC、血浆DAO、D-乳酸、PCT、血清CITH3水平均呈正相关(r=0.643、0.591、0.466、0.614、0.464,r=0.528、0.424、0.726、0.766、0.710,P <0.05)。结论 脓毒症患者肠道屏障功能指标及炎症反应指标表达增加与疾病进展及预后不良密切相关,可作为脓毒症疾病进展及预后判断的定量指标。

Objective To analyze the changes of intestinal barrier function indicators in sepsis patients with different disease progression and prognosis. Methods A total of 454 patients with sepsis admitted to our hospital from July 2017 to March 2020were selected as the research subjects. They were divided into a sepsis group(153 cases), a severe sepsis group(189 cases) and a septic shock group(112 cases) according to the severity of the disease, and their clinical data were collected retrospectively. The intestinal barrier function indexes, infl ammatory indexes, and disease progression scores of the three groups were compared, and the correlations among them were analyzed by Pearson correlation analysis. Results The levels of the whole blood white blood cell count(WBC), serum diamine oxidase(DAO), D-lactic acid, procalcitonin(PCT), serum citrullinated histone H3(CITH3), the scores of the Acute Physiology and Chronic Health Evaluation(APACHE II) and Sequential Organ Failure Assessment(SOFA)showed an upward trend in all of the three groups, and the dif ferences among them were statistically signifi cant(P<0.05). The levels of serum endotoxin in the severe sepsis group and the septic shock group were higher than that in the sepsis group(P<0.05).The levels of the whole blood WBC, plasma DAO, D-lactic acid, PCT, serum CITH3, endotoxin, and the scores of APACHE II and SOFA in the death group were higher than those in the survival group(P<0.05). The scores APACHE II and SOFA were positively correlated with the levels of the whole blood WBC, plasma DAO, D-lactic acid, PCT, and serum CITH3(r=0.643, 0.591, 0.466,0.614, 0.464, r=0.528, 0.424, 0.726, 0.766, 0.710, P<0.05). Conclusion The increased expression of the intestinal barrier function indexes and inflammatory response indexes in sepsis patients is closely related to their disease progression and poor prognosis,which can be used as a quantitative indicator for the judgment of the disease progression and prognosis, and is worthy of further clinical research and application.