血浆GLP-2评估严重脓毒症及脓毒性休克患者肠道功能的临床研究
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摘要
目的研究血浆胰高血糖素样肽-2(GLP-2)水平对严重脓毒症及脓毒性休克患者肠道功能及预后的评估价值。方法选取2015年12月至2017年10月在该院ICU住院的严重脓毒症及脓毒性休克患者60例作为脓毒症组,检测入院12h的GLP-2水平。同时选取在该院体检的健康人29例作为对照组,检测其GLP-2水平,比较脓毒症组与对照组的GLP-2水平是否存在差异。将脓毒症患者分为急性胃肠损伤(AGI)Ⅰ、AGIⅡ、AGIⅢ组及AGIⅣ组,依据预后分为存活组与死亡组,分别比较分析不同AGI分级及不同预后患者的血浆GLP-2水平。结果脓毒症组的GLP-2水平明显低于对照组,差异有统计学意义(P<0.05)。不同AGI分级的脓毒症患者GLP-2水平的差异有统计学意义(P<0.05),Bonferroni比较显示,AGIⅠ、AGIⅡ组比较,GLP-2水平差异无统计学意义(P>0.05),AGIⅢ、AGIⅣ组比较,GLP-2水平差异无统计学意义(P>0.05),其他组之间的差异均有统计学意义(P<0.05)。相关分析显示AGI分级与GLP-2水平呈负相关关系(r=0.87,P=0.007)。生存组GLP-2水平与死亡组比较,差异无统计学意义(P>0.05)。结论脓毒症患者GLP-2水平下降,GLP-2水平能够用于评价严重脓毒症及脓毒性休克患者的肠道功能;但目前尚未发现GLP-2水平与脓毒症预后有关。
Objective To explore the appraisal value of plasma GLP-2 level in the intestinal function of the patients with severe sepsis and sepsis shock.Methods Sixty patients with severe sepsis and sepsis shock in ICU of the hospital from December 2015 to October 2017.29 were selected as the sepsis group.The GLP-2 level was detected at 12 hafter admission.Meanwhile 29 healthy people undergoing the physical examination in this hospital served as the control group and their GLP-2 levels were detected.The difference in GLP-2 level was compared between the sepsis group and control group.The sepsis group was divided into the AGI groupⅠ,Ⅱ,Ⅲ and Ⅳ,and survival group and death group according to the clinical outcomes.Then the plasma GLP-2 levels were compared and analyzed among different AGI grades and between different prognosis.Results The GLP-2 level in the sepsis group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The GLP-2 level had statistically significant difference among different AGI groups(P<0.05).The Bonferroni comparison showed that the GLP-2 level had no statistically significant difference among the AGIⅠand AGIⅡ,AGIⅢand AGIⅣ groups(P>0.05).The difference among other groups was statistically significant(P<0.05).The correlation analysis showed that there was a negative correlation between the AGI classification and GLP-2 level(r=0.87,P=0.007).The GLP-2 level had no statistical difference between the survival group and death group(P>0.05).Conclusion The GLP-2 level in the patients with sepsis is decreased.The GLP-2 level can be used to evaluate the intestinal function in the patients with severe sepsis and sepsis shock.It is not yet found that the GLP-2 level has an association with the sepsis prognosis.
Objective To explore the appraisal value of plasma GLP-2 level in the intestinal function of the patients with severe sepsis and sepsis shock.Methods Sixty patients with severe sepsis and sepsis shock in ICU of the hospital from December 2015 to October 2017.29 were selected as the sepsis group.The GLP-2 level was detected at 12 hafter admission.Meanwhile 29 healthy people undergoing the physical examination in this hospital served as the control group and their GLP-2 levels were detected.The difference in GLP-2 level was compared between the sepsis group and control group.The sepsis group was divided into the AGI groupⅠ,Ⅱ,Ⅲ and Ⅳ,and survival group and death group according to the clinical outcomes.Then the plasma GLP-2 levels were compared and analyzed among different AGI grades and between different prognosis.Results The GLP-2 level in the sepsis group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The GLP-2 level had statistically significant difference among different AGI groups(P<0.05).The Bonferroni comparison showed that the GLP-2 level had no statistically significant difference among the AGIⅠand AGIⅡ,AGIⅢand AGIⅣ groups(P>0.05).The difference among other groups was statistically significant(P<0.05).The correlation analysis showed that there was a negative correlation between the AGI classification and GLP-2 level(r=0.87,P=0.007).The GLP-2 level had no statistical difference between the survival group and death group(P>0.05).Conclusion The GLP-2 level in the patients with sepsis is decreased.The GLP-2 level can be used to evaluate the intestinal function in the patients with severe sepsis and sepsis shock.It is not yet found that the GLP-2 level has an association with the sepsis prognosis.
引文
[1]中华医学会重症医学分会.中国严重脓毒症脓毒性休克治疗指南(2014)[J].中国实用乡村医生杂志,2015,27(18):5-10.
[2]方媛媛,鲁厚清.胰高血糖素样肽-2与脓毒症肠道的保护[J].海南医学,2017,28(3):456-458.
[3]郝昱芳,耿立霞.脓毒症中介质的最新研究进展[J].中华危重病急救医学,2016,28(2):188-192.
[4] SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[5]代晓明,黄伟.2016重症医学回顾与展望[J].中华危重病急救医学,2017,29(1):1-5.
[6]黄伟.2017重症医学临床研究回顾与展望[J].中华危重病急救医学,2018,30(1):1-7.
[7] VAISHNAVI C.Translocation of gut flora and its role in sepsis[J].Ind J Med Microbiol,2013,31(4):334-342.
[8]杨秀芬,李栋梁,周庆明.脓毒症致肠功能衰竭研究进展[J].河北医科大学学报,2014,35(11):1357-1360.
[9]任建安.危重患者急性胃肠损伤与肠康复治疗[J].中华消化外科杂志,2013,12(1):21-24.
[10]李锂,胡予.胰高血糖素样肽-2的生理功能和临床应用[J].中华消化杂志,2014,34(7):500-502.
[11]WALKER M P,EVOCK-CLOVER C M,ELSASSER T H,et al.Short communication:glucagon-like peptide-2and coccidiosis alter tight junction gene expression in the gastrointestinal tract of dairy calves1[J].J Dairy Sci,2015,98(5):3432-3437.
[12]DONG C X,ZHAO W,SOLOMON C,et al.The intestinal epithelial insulin-like growth factor-1receptor links glucagon-like peptide-2action to gut barrier function[J].Endocrinology,2014,155(2):370-379.
[13]HSIEH J,TRAJCEVSKI K E,FARR S L,et al.Glucagon-like peptide 2(GLP-2)stimulates postprandial chylomicron production and postabsorptive release of intestinal triglyceride storage pools via induction of nitric oxide signaling in male hamsters and mice[J].Endocrinology,2015,156(10):3538-3547.
[14]ITURRINO J,CAMILLERI M,ACOSTA A,et al.Acute effects of a glucagon-like peptide 2analogue,teduglutide,on gastrointestinal motor function and permeability in adult patients with short bowel syndrome on home parenteral nutrition[J].J Parent Ent Nut,2016,40(8):1089-1095.
[15]NAKAME K,KAJI T,MUKAI M,et al.The protective and anti-inflammatory effects of glucagon-like peptide-2in an experimental rat model of necrotizing enterocolitis[J].Peptides,2016,75(1):1-7.
[16]MAYO B J,STRINGER A M,BOWEN J M,et al.Irinotecan-induced mucositis:the interactions and potential role of GLP-2analogues[J].Cancer Chemother Pharmacol,2017,79(2):233-249.
[17]LIU X W,MURALI S G,HOLST J J,et al.Enteral nutrients potentiate the intestinotrophic action of glucagonlike peptide-2in association with increased insulin-like growth factor-Ⅰresponses in rats[J].Am J Physiol Regul Integr Comp Physiol,2008,295(6):1794-1802.
[18]AUSTIN K,MARKOVIC M A,BRUBAKER P L.Current and potential therapeutic targets of glucagon-like peptide-2[J].Curr Opin Pharmacol,2016,31(1):13-18.
[19]张宗兵,刘瑞林,刘牧林.GLP-2对脓毒症大鼠肠道细菌移位的影响[J].中华全科医学,2012,10(7):999-1000.
[20]张宗兵,王栓虎,姜从桥,等.胰高血糖素样肽-2对脓毒症大鼠肠黏膜通透性的影响[J].中华解剖与临床杂志,2014,19(5):423-426.
[2]方媛媛,鲁厚清.胰高血糖素样肽-2与脓毒症肠道的保护[J].海南医学,2017,28(3):456-458.
[3]郝昱芳,耿立霞.脓毒症中介质的最新研究进展[J].中华危重病急救医学,2016,28(2):188-192.
[4] SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[5]代晓明,黄伟.2016重症医学回顾与展望[J].中华危重病急救医学,2017,29(1):1-5.
[6]黄伟.2017重症医学临床研究回顾与展望[J].中华危重病急救医学,2018,30(1):1-7.
[7] VAISHNAVI C.Translocation of gut flora and its role in sepsis[J].Ind J Med Microbiol,2013,31(4):334-342.
[8]杨秀芬,李栋梁,周庆明.脓毒症致肠功能衰竭研究进展[J].河北医科大学学报,2014,35(11):1357-1360.
[9]任建安.危重患者急性胃肠损伤与肠康复治疗[J].中华消化外科杂志,2013,12(1):21-24.
[10]李锂,胡予.胰高血糖素样肽-2的生理功能和临床应用[J].中华消化杂志,2014,34(7):500-502.
[11]WALKER M P,EVOCK-CLOVER C M,ELSASSER T H,et al.Short communication:glucagon-like peptide-2and coccidiosis alter tight junction gene expression in the gastrointestinal tract of dairy calves1[J].J Dairy Sci,2015,98(5):3432-3437.
[12]DONG C X,ZHAO W,SOLOMON C,et al.The intestinal epithelial insulin-like growth factor-1receptor links glucagon-like peptide-2action to gut barrier function[J].Endocrinology,2014,155(2):370-379.
[13]HSIEH J,TRAJCEVSKI K E,FARR S L,et al.Glucagon-like peptide 2(GLP-2)stimulates postprandial chylomicron production and postabsorptive release of intestinal triglyceride storage pools via induction of nitric oxide signaling in male hamsters and mice[J].Endocrinology,2015,156(10):3538-3547.
[14]ITURRINO J,CAMILLERI M,ACOSTA A,et al.Acute effects of a glucagon-like peptide 2analogue,teduglutide,on gastrointestinal motor function and permeability in adult patients with short bowel syndrome on home parenteral nutrition[J].J Parent Ent Nut,2016,40(8):1089-1095.
[15]NAKAME K,KAJI T,MUKAI M,et al.The protective and anti-inflammatory effects of glucagon-like peptide-2in an experimental rat model of necrotizing enterocolitis[J].Peptides,2016,75(1):1-7.
[16]MAYO B J,STRINGER A M,BOWEN J M,et al.Irinotecan-induced mucositis:the interactions and potential role of GLP-2analogues[J].Cancer Chemother Pharmacol,2017,79(2):233-249.
[17]LIU X W,MURALI S G,HOLST J J,et al.Enteral nutrients potentiate the intestinotrophic action of glucagonlike peptide-2in association with increased insulin-like growth factor-Ⅰresponses in rats[J].Am J Physiol Regul Integr Comp Physiol,2008,295(6):1794-1802.
[18]AUSTIN K,MARKOVIC M A,BRUBAKER P L.Current and potential therapeutic targets of glucagon-like peptide-2[J].Curr Opin Pharmacol,2016,31(1):13-18.
[19]张宗兵,刘瑞林,刘牧林.GLP-2对脓毒症大鼠肠道细菌移位的影响[J].中华全科医学,2012,10(7):999-1000.
[20]张宗兵,王栓虎,姜从桥,等.胰高血糖素样肽-2对脓毒症大鼠肠黏膜通透性的影响[J].中华解剖与临床杂志,2014,19(5):423-426.
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