【摘要】 目的探讨成纤维细胞生长因子19(FGF-19)联合肠脂肪酸结合蛋白(IFABP)对儿童重型创伤性脑损伤(TBI)合并胃肠功能障碍的诊断价值。方法收集2018年1月-2020年12月于天津市儿童医院神经外科重症病房(NICU)住院的重型TBI患儿56例为研究对象。入NICU时,均行血清IFABP、FGF-19水平的检测。按有无胃肠功能障碍将入组患儿分为TBI合并胃肠功能障碍组(n=22)与TBI未合并胃肠功能障碍组(n=34),比较两组血清IFABP、FGF-19水平。应用多因素Logistic回归模型分析儿童重型TBI合并胃肠功能障碍的相关因素,并应用受试者工作特征曲线(ROC)评估血清IFABP、FGF-19对儿童重型TBI合并胃肠功能障碍的诊断效能。结果 56例患儿,NICU病死率为23.21%(13/56);TBI合并胃肠功能障碍组病死率为27.27%,相比TBI未合并胃肠功能障碍组(20.59%)呈增高趋势,但差异无统计学意义(P>0.05)。TBI合并胃肠功能障碍组入NICU时血清IFABP显著高于TBI未合并胃肠功能障碍组[(526.87±112.63)pg/ml vs(398.25±94.58)pg/ml,P<0.05],FGF-19显著低于TBI未合并胃肠功能障碍[(50.21±15.36)μg/ml vs(75.43±17.82)μg/ml,P<0.05]。Logistic回归分析显示,IFABP(OR=1.129,95%CI:1.007-1.265)、FGF-19(OR=0.937,95%CI:0.887-0.990)均是重型TBI患儿合并胃肠功能障碍的独立相关因素(P<0.05)。ROC曲线分析显示,IFABP预测儿童重型TBI合并胃肠功能障碍的曲线下面积为0.878(95%CI:0.763-0.950),FGF-19对应的曲线下面积为0.851(95%CI:0.730-0.932),两者效能比较差异无统计学意义(P>0.05);二者联合的曲线下面积为0.975(95%CI:0.892-0.998),均高于单一IFABP或FGF-19,差异有统计学意义(P<0.05)。结论血清IFABP、FGF-19均可作为儿童重型TBI合并胃肠功能障碍的敏感指标,二者联合使用能够提高诊断效能。更多还原

【Abstract】 Objective To investigate the diagnostic value of fibroblast growth factor 19(FGF-19)combined with intestinal fatty acid binding protein(IFABP)on children patients with severe traumatic brain injury(TBI)complicated with gastrointestinal dysfunction.Methods A total of 56 children patients with severe TBI hospitalized in the neurosurgical intensive care unit(NICU)of the hospital from January 2018 to December 2020 were collected as the research subjects.When entering NICU,levels of serum IFABP and FGF-19 were detected.According to the presence or absence of gastrointestinal dysfunction,the enrolled children patients were divided into TBI with gastrointestinal dysfunction group(n=22)and TBI without gastrointestinal dysfunction group(n=34).Levels of serum IFABP and FGF-19 were compared between the two groups.Multivariate Logistic regression model was used to analyze the related factors of children patients with TBI complicated with gastrointestinal dysfunction,and receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy of serum IFABP and FGF-19 on children with TBI complicated with gastrointestinal dysfunction.Results Among 56 children patients,the fatality rate in NICU was 23.21%(13/56).The fatality rate of TBI with gastrointestinal dysfunction group was 27.27%,which was higher than that of TBI without gastrointestinal dysfunction group(20.59%)(P>0.05).The levels of serum IFABP of TBI with gastrointestinal dysfunction group was significantly higher than that of TBI without gastrointestinal dysfunction group at entering NICU[(526.87±112.63)pg/ml vs(398.25±94.58)pg/ml,P<0.05]while the level of FGF-19 was significantly lower than that of TBI without gastrointestinal dysfunction group[(50.21±15.36)μg/ml vs(75.43±17.82)μg/ml,P<0.05].Logistic regression analysis showed that IFABP(OR=1.129,95%CI:1.007-1.265)and FGF-19(OR=0.937,95%CI:0.887-0.990)were independent related factors of gastrointestinal dysfunction in children patients with TBI(P<0.05).ROC curve analysis showed that the area under the curve of IFABP in predicting gastrointestinal dysfunction in children with TBI was 0.878(95%CI:0.763-0.950),and the area under the curve corresponding to FGF-19 was0.851(95%CI:0.730-0.932)(P>0.05).The area under the curve of the combination of the two was 0.975(95%CI:0.892-0.998),which was higher than that of IFABP or FGF-19(P<0.05).Conclusion Serum IFABP and FGF-19 can be used as sensitive indicators for children with TBI complicated with gastrointestinal dysfunction,and the combination of the two can improve the diagnostic efficacy.更多还原