目的: 探究脓毒症合并肠道损伤患者的临床危险因素。方法: 前瞻性观察2023年5月-2024年3月包头医学院第一附属医院重症医学科(ICU)脓毒症合并肠道损伤的患者68例,进行临床分析。结果: 急性胃肠损伤(acute gastrointestinal injury, AGI)Ⅲ-Ⅳ级患者鞘氨醇激酶1(sphingosine kinase 1, Sphk1)、鞘氨醇1磷酸(sphingosine 1-phosphate, S1p)、鞘氨醇-1-磷酸受体1(sphingosine 1-phosphate receptor 1, S1pr1)、鞘氨醇-1-磷酸受体2(sphingosine 1-phosphate receptor 2, S1pr2)、D-乳酸、急性生理与慢性健康评分(acute physiology and chronic health evaluation score, APACHE Ⅱ)及病死率高于AGI Ⅰ-Ⅱ级(P＜0.05);AGI Ⅳ级APACHE Ⅱ评分及病死率高于AGI Ⅲ级(P＜0.05);随着AGI分级升高,肠脂肪酸结合蛋白水平(intestinal fatty acid binding protein, I-FABP)升高(P＜0.05)。死亡组AGI分级、住ICU的时间、APACHE Ⅱ评分高于生存组(P＜0.05);死亡组Sphk1、S1P、S1PR1、S1PR2、乳酸(lactic acid,Lac)均高于生存组(P＜0.05);Logistic显示:Lac、APACHE Ⅱ评分、AGI分级可能是患者28 d死亡的独立影响因素。Lac、APACHE Ⅱ 评分、AGI分级联合预测,曲线下面积(AUC)为0.911,敏感性94.4%、特异性80.0%。结论: 随着AGI分级升高,Sphk1、S1P、S1pr1、S1pr2、D-乳酸、IFABP、APACHE Ⅱ评分及病死率也升高。Lac、APACHE Ⅱ评分、AGI分级可能是脓毒症合并肠道损伤患者死亡独立危险因素,三者联合具有较好的预后价值。
Objective: To investigate the clinical risk factors in patients with sepsis complicated with intestinal injury. Methods: From May 2023 to March 2024,68 patients with sepsis and intestinal injury in intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College were prospectively observed and analyzed. Results: The levels of sphingosine kinase 1 (Sphk1), sphingosine 1-phosphate (S1p), sphingosine 1-phosphate receptor 1 (S1pr1), sphingosine 1-phosphate receptor 2 (S1pr2), D-lactic acid, acute physiology and chronic health evaluation score (APACHE Ⅱ) and mortality in patients with acute gastrointestinal injury (AGI) grade Ⅲ-Ⅳ were higher than those in AGI grade Ⅰ-Ⅱ (P＜0.05). The APACHE Ⅱ score and mortality of AGI grade Ⅳ were higher than those of AGI grade Ⅲ (P＜0.05). With the increase of AGI grade, the level of intestinal fatty acid binding protein (I-FABP) increased (P＜0.05). The AGI grade, ICU stay time and APACHE Ⅱ score in the death group were higher than those in the survival group (P＜0.05). The levels of Sphk1, S1P, S1PR1, S1PR2 and lactic acid (Lac) in the death group were higher than those in the survival group (P＜0.05). Logistic analysis showed that Lac, APACHE Ⅱ score and AGI grade may be independent influencing factors of 28-day death. The area under the curve (AUC) of combined prediction of Lac, APACHE Ⅱ score and AGI grade was 0.911, the sensitivity was 94.4% and the specificity was 80.0%. Conclusion: With the increase of AGI grade, Sphk1, S1P, S1pr1, S1pr2, D-lactic acid, IFABP, APACHE Ⅱ score and mortality also increased. Lac, APACHE Ⅱ score and AGI grade may be independent risk factors for death in patients with sepsis complicated with intestinal injury, and the combination of the three has good prognostic value.
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