Value of gastrointestinal hormone levels in judgment of prognosis of critically ill children with gastrointestinal dysfunction
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摘要:目的 探讨胃肠激素水平变化在胃肠功能障碍危重患儿预后判断中的价值。方法 选取合并胃肠功能障碍的重症患儿696例作为研究对象,患儿入院后均接受常规治疗(包括抗感染、机械通气、维持内环境、保护胃肠道黏膜、营养支持等治疗),入院后采集静脉血检测胃肠激素[胃泌素(GAS)、胃动素(MOT)、生长抑素(SS)]、炎症指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平,采用胃肠功能评分(SNGF)评价胃肠功能障碍程度,并将患儿分为轻度组(SNGF < 2分)、中度组(SNGF 2~4分)和重度组(SNGF>4分)。结果 轻度组各胃肠激素水平与中度组比较,差异无统计学意义(P>0.05);重度组GAS、MOT水平低于轻度组和中度组,SS水平高于轻度组和中度组,差异有统计学意义(P < 0.05)。轻度组IL-6、TNF-α水平与中度组比较,差异无统计学意义(P>0.05);重度组IL-6、TNF-α水平高于轻度组和中度组,差异有统计学意义(P < 0.05);中度组CRP水平高于轻度组,重度组CRP水平高于中度组,差异有统计学意义(P < 0.05)。IL-6、TNF-α、CRP与SS呈显著正相关(P < 0.05),与GAS、MOT呈显著负相关(P < 0.05)。存活患儿GAS、MOT水平高于死亡患儿,SS水平低于死亡患儿,差异有统计学意义(P < 0.05)。结论 胃肠激素水平能一定程度反映胃肠功能障碍的严重程度,尤其对重症胃肠功能障碍患儿的预后具有判断价值。Abstract:Objective To explore the value of changes of gastrointestinal hormone levels in judgment of prognosis of critically ill children with gastrointestinal dysfunction.Methods A total of 696 critically ill children with gastrointestinal dysfunction were enrolled in this study. After admission, they were given routine treatment, including anti-infection, mechanical ventilation, maintenance of internal environment, protection of gastrointestinal mucosa, nutritional support and other treatments. The blood samples of all enrolled children were collected to detect gastrointestinal hormone[gastrin (GAS), motilin (MOT), somatostatin (SS)] and inflammatory indexes [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP)]. Gastrointestinal dysfunction score (SNGF) was used to evaluate degree of gastrointestinal dysfunction and the patients were divided into mild group (SNGF score < 2), moderate group (SNGF score ranging from 2 to 4) and severe group (SNGF score>4).Results There were no significant differences in gastrointestinal hormone levels between the mild group and the moderate group (P>0.05). The GAS and MOT levels in the severe group were significantly lower, and the SS level in the severe group was significantly higher than those in the mild illness group and the moderate group (P < 0.05). IL-6 and TNF-α levels in the mild illness group showed significant differences compared with the moderate group (P>0.05), and were significantly higher in the severe group than those in the mild illness group and the moderate group (P < 0.05). The level of CRP in the moderate group was significantly higher than that in the mild group, and was significantly higher in the severe group than that in the moderate group (P < 0.05). IL-6, TNF-α and CRP levels were positively correlated with SS (P < 0.05), and negatively correlated with GAS and MOT (P < 0.05). The levels of GAS and MOT of surviving children were higher, and the levels of SS were lower than those of the death (P < 0.05).Conclusion The level of gastrointestinal hormone can reflect the severity of gastrointestinal dysfunction to some extent, and has especial value in judgment of prognosis of children with severe gastrointestinal dysfunction.
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表 1 3组患儿基本资料比较(x±s)[n(%)]
指标 n 轻度组(n=155) 中度组(n=394) 重度组(n=147) 原发病 呼吸系统疾病 447 73(16.33) 287(64.21) 87(19.46) 神经系统疾病 102 33(32.35) 48(47.06) 21(20.59) 免疫系统疾病 64 17(26.56) 26(40.63) 21(32.81) 外科重症 72 28(38.89) 29(40.28) 15(20.83) 结缔组织病 11 4(36.36) 4(36.36) 3(27.27) SNGF/分 696 1.03±0.38 3.07±0.35* 5.36±0.44*# SNGF: 胃肠功能评分。与轻度组比较, *P < 0.05; 与中度组比较, #P < 0.05。 表 2 3组患儿胃肠激素和炎症指标水平比较(x±s)
组别 GAS/(pg/mL) MOT/(pg/mL) SS/(pg/mL) IL-6/(ng/L) TNF-α/(ng/L) CRP/(mg/L) 轻度组(n=155) 44.25±7.59 144.19±6.39 52.49±11.48 8.37±5.81 20.13±3.26 15.72±5.64 中度组(n=394) 38.76±8.44 125.02±11.48 62.59±7.38 12.64±6.29 25.29±4.67 33.61±4.64* 重度组(n=147) 24.42±10.03*# 98.38±9.45*# 107.45±18.48*# 34.52±11.37*# 38.67±6.91*# 49.63±5.26*# GAS: 胃泌素; MOT: 胃动素; SS: 生长抑素; IL-6: 白细胞介素-6; TNF-α: 肿瘤坏死因子-α; CRP: C反应蛋白。与轻度组比较, *P < 0.05; 与中度组比较, #P < 0.05。 表 3 存活患儿与死亡患儿胃肠激素水平比较(x±s)
pg/mL 组别 n GAS MOT SS 存活组 659 39.47±13.62 130.29±25.43 61.54±12.20 死亡组 37 17.51±11.85* 75.82±16.27* 127.13±20.57* GAS: 胃泌素; MOT: 胃动素; SS: 生长抑素。
与存活组比较, *P < 0.05。 -
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