【摘要】 目的 评估急性胃肠道损伤(AGI)和肠脂肪酸结合蛋白(I-FABP)在肝硬化脓毒症患者预后中的价值。方法 回顾性分析2020年9月—2023年3月某院重症监护病房(ICU)收治的84例肝硬化脓毒症患者临床资料，并选择同期41例失代偿期肝硬化患者作为对照组。采用酶联免疫吸附测定(ELISA)法测定患者血清I-FABP水平。计算入院终末期肝病模型(MELD)和序贯器官衰竭评估(SOFA)评分，根据住院病历评估AGI程度，观察30天和90天生存状况。采用Spearman相关分析判断变量间相关性，多因素Cox回归分析确定肝硬化脓毒症死亡的危险因素。采用受试者工作特征(ROC)曲线确定最佳临界值，ROC曲线下面积(AUC)比较诊断效能。结果 肝硬化脓毒症组患者AGI分级和I-FABP水平均高于对照组(均P<0.05)。肝硬化脓毒症患者I-FABP与降钙素原(PCT)、MELD和SOFA评分均相关(均P<0.05),AGI分级与SOFA评分呈正相关(P=0.038)。肝硬化脓毒症组患者30天病死率为25.0%(21例),90天病死率为35.7%(30例)。多因素Cox回归分析显示，基线I-FABP、SOFA评分与30天和90天生存结局独立相关，且I-FABP四分位数显示出良好的预后区分能力。ROC曲线显示，I-FABP能明显提高SOFA评分对患者预后的预测效能。结论 肝硬化脓毒症患者AGI分级和I-FABP水平明显升高。血清I-FABP与患者预后相关，并可提高SOFA评分对生存结局的预测效能。更多还原

【Abstract】 Objective To assess the value of acute gastrointestinal injury(AGI) and intestinal fatty acid-binding protein(I-FABP) in the prognosis of liver cirrhotic patients with sepsis. Methods Clinical data of 84 liver cirrhosis patients with sepsis who were admitted to the intensive care unit(ICU) of a hospital from September 2020 to March 2023 were analyzed retrospectively, and 41 patients with decompensated liver cirrhosis during the same period were selected as the control group. Serum I-FABP level in patients was determined with enzyme-linked immunosorbent assay(ELISA). Scores of the model of end-stage liver disease(MELD) and sequential organ failure assessment(SOFA) were calculated. AGI was evaluated based on medical records. 30-day and 90-day survival was observed. Correlation among variables was analyzed by Spearman correlation. Risk factors for death in patients with liver cirrhosis and sepsis was determined by multivariate Cox regression analysis. The optimal cut-off value was determined by receiver operating characteristic(ROC) curve, and the diagnostic efficacy was compared through the area under the ROC curve(AUC). Results Both AGI grading and I-FABP level in liver cirrhosis patients with sepsis were higher than those in the control group(both P<0.05). I-FABP level was correlated with procalcitonin(PCT), MELD, and SOFA scores in patients with liver cirrhosis and sepsis(all P<0.05). AGI grading was positively correlated with SOFA score(P=0.038). The 30-day and 90-day mortality of patients in the liver cirrhosis with sepsis group were 25.0%(n=21) and 35.7%(n=30), respectively. Multivariate Cox regression analysis showed that baseline I-FABP and SOFA scores were independently correlated with 30-day and 90-day survival, and the I-FABP quartile showed good prognostic differentiation efficacy. ROC curve showed that I-FABP could significantly improve the predictive effect of SOFA score on the prognosis of patients. Conclusion AGI grading and I-FABP level in liver cirrhosis patients with sepsis are elevated significantly. Serum I-FABP is associated with the prognosis of patient and can improve the predictive efficacy of SOFA score for survival.更多还原