血内毒素在非脓毒症危重患者中预测胃肠功能不全的价值

Serum endotoxin to predict the gastrointestinal dysfunction in non-septic critical patients

目的评价血内毒素在非脓毒症危重患者中预测胃肠功能不全的价值。方法前瞻性观察收入ICU的非脓毒症危重患者78例,收集入住ICU时间、APACHEⅡ评分、胃肠道功能障碍发生例数及预后情况,检测血内毒素、血白细胞、血C反应蛋白、血降钙素原,并分析以上临床指标与血内毒素关系,并通过胃肠功能障碍检验ROC曲线及最高Youden指数法取预测胃肠功能障碍的最佳截断值并评价其临床价值。结果发生胃肠功能障碍患者的血内毒素水平高于胃肠功能正常患者的血内毒素水平,组间差异有统计学意义(P<0.05);其他临床指标与血内毒素相关性无统计学意义(均P>0.05)。0.025 5 EU/ml为预测胃肠道功能不全的最佳截断值,其灵敏度0.875,特异度为0.200。结论非脓毒症危重患者的血内毒素水平与胃肠功能障碍的发生有关,但内毒素预测非脓毒症患者胃肠功能不全的价值有限。

Objective To estimate the value of the serum endotoxin to predict the gastrointestinal dysfunction in non-septic critical patients. Methods 78 non-septic critical patients enrolled in our intensive care unit were observed prospectively. The data of days stayed in the ICU, APACHE Ⅱ score, case of gastrointestinal dysfunction and prognostic were colleted. And the serum endotoxin, white blood cell, C-reaction protein and procalcitonin was detected. After that, the relationships between serum endotoxin and above clinical items were analyzed. The cut-off serum endotoxin with the highest Youden index was adopted from the ROC curve for gastrointestinal dysfunction, and its sensitivity and specificity was observed. Results The serum endotoxin concentration in the patients with gastrointestinal dysfunction was significantly higher than that in the patients with normal gastrointestinal function(P<0.05). However, no statistical significantly difference was found between serum endotoxin concentration and other clinical item(all P>0.05). And the cut-off serum endotoxin concentration with highest Youden index was 0.025 5 EU/ml and its sensitivity was 0.875 and specificity was 0.200. Conclusion The serum endotoxin was related to the gastrointestinal function in the non-septic critical patients, but its value to predict the gastrointestinal dysfunction is limited in non-septic critical patients.