严重多发伤患者血浆肠脂肪酸结合蛋白水平变化及其与胃肠功能障碍的关系

目的探讨严重多发伤患者血浆肠脂肪酸结合蛋白(iFABP)水平变化及其与创伤后胃肠功能障碍的关系。方法36例多发伤患者分为轻伤组(ISS评分<16分,15例)和重伤组(ISS评分>16分,21例),再根据是否并发胃肠功能障碍分为胃肠功能障碍组(32例)和非胃肠功能障碍组(4例),另10例择期手术者为正常对照组。正常对照组采外周静脉血1次,多发伤患者分别于伤后第1、3、5天采外周静脉血3次,采用酶联免疫吸附测试法检测iFABP。结果与正常对照组相比,轻伤组和重伤组血浆iFABP水平于伤后第1天即显著升高(P<0.01),且重伤组显著高于轻伤组(P<0.01),随后iFABP水平逐渐下降,轻伤组于第5天恢复至正常水平,而重伤组仍显著高于正常对照组(P<0.01);胃肠功能障碍组伤后第1天血浆iFABP水平显著高于非胃肠功能障碍组(P<0.01),其差异一直持续到创伤后第5天。多发伤后第1、3、5天血浆iFABP水平与胃肠功能障碍评分均有相关性。结论严重多发伤后早期血浆iFABP水平显著升高,其水平变化与创伤严重程度和胃肠功能障碍程度呈正相关,这种变化可能对创伤后胃肠功能障碍的早期预测有较重要意义。

Relationship between gastrointestinal dysfunction and the changes of plasma intestinal fatty-acid binding protein (iFABP) levels in the patients with severe multiple injury

Objective To explore the relationship between gastrointestinal dysfunction and the level of plasma intestinal fatty-acid binding protein (iFABP) in severe multiple injury patients. Methods 36 patients with severe multiple injury were divided into mild injury group (15 patients, ISS<16) and severe multiple injury group (21 patients, ISS>16) according to ISS score and divided into gastrointestinal dysfunction group (32 patients) and non-gastrointestinal dysfunction group (4 patients) according to the patients with or without gastrointestinal dysfunction. 10 patients of selective operation were served as the control group. Venous blood was collected from control group for once, and from two other groups on 1st, 3rd and 5th day respectively after trauma. The concentration of plasma iFABP was measured by enzyme linked immunosorbent assay. Results Compared with the control group, the iFABP levels in the mild injury group and the severe injury group were both increased obviously on 1st day after trauma (P<0.01), and were higher in the severe injury group than in the mild injury group (P<0.01). Subsequently, the iFABP level decreased and recovered to normal on 5th day after trauma in the mild injury group, but iFABP level was higher obviously in the severe injury group than in control group (P<0.01). Compared with the non-gastrointestinal dysfunction group, the iFABP level in the gastrointestinal dysfunction group was higher on 1st day (P<0.01), and the differences existed on 5th day after trauma. The level of the iFABP was highly relevant to the degree of gastrointestinal dysfunction. Conclusion Plasma iFABP levels in the multiple injury patients show significant increase after trauma, which is highly relevant to injury severity and degree of gastrointestinal dysfunction. Therefore, at the early stage after severe trauma, the level of plasma iFABP may play an important role in early prediction of the gastrointestinal dysfunction.