上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (09): 1236-1242.doi: 10.3969/j.issn.1674-8115.2020.09.012

• 论著·临床研究 • 上一篇    下一篇

成纤维细胞生长因子19预测儿童脓毒症合并胃肠功能障碍的临床价值

唐晓梦1, 2，任玉倩1，熊 熙1, 2，缪惠洁1，邵卢晶1, 2，崔 云1，张育才1, 2，王春霞1, 2   

  1. 1. 上海交通大学附属儿童医院重症医学科，上海200062；2. 上海交通大学儿童感染免疫与重症医学研究院，上海200062
  • 出版日期:2020-09-28 发布日期:2020-11-04
  • 通讯作者: 王春霞，电子信箱：karencx0465@163.com。
  • 作者简介:唐晓梦（1995—），女，硕士生；电子信箱：xiaomengmeng77@hotmail.com。
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划（20171928）；上海市科学技术委员会“科技创新行动计划”项目（18411951000）；上海市自然科学基金（19ZR1442500）。

Clinical value of fibroblast growth factor 19 in predicting gastrointestinal dysfunction in children with sepsis

TANG Xiao-meng1, 2, REN Yu-qian1, XIONG Xi1, 2, MIAO Hui-jie1, SHAO Lu-jing1, 2, CUI Yun1, ZHANG Yu-cai 1, 2, WANG Chun-xia1, 2   

  1. 1. Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China; 2. Institute of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
  • Online:2020-09-28 Published:2020-11-04
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant support (20171928); Scientific and Technological Innovation Program of Science and Technology Commission of Shanghai Municipality (18411951000)；Shanghai Natural Science Foundation (19ZR1442500).

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摘要： 目的·探讨成纤维细胞生长因子19（fibroblast growth factor 19，FGF19）预测脓毒症患儿胃肠功能障碍的潜在价值。方法·前瞻性纳入2018年1月至2018年12月上海交通大学附属儿童医院儿童重症监护病房（pediatric intensive care unit，PICU）收治的101例脓毒症患儿，排除11例血清FGF19值缺失患儿，共90例患儿纳入分析。根据是否存在胃肠道功能障碍，将其分为脓毒症合并胃肠道功能障碍组（n=32）和脓毒症未合并胃肠道功能障碍组（n=58）。入PICU时检测血清FGF19水平，采用非参数检验（Mann-Whitney U检验）比较2组患儿间FGF19水平的差异，多因素Logistic回归分析脓毒症合并胃肠功能障碍的相关因素。结果·PICU患儿病死率为12.2%（11/90）。脓毒症合并胃肠功能障碍组的PICU患儿病死率高于未合并胃肠道功能障碍组，但差异无统计学意义（18.8% vs 8.6%，P=0.160）。脓毒症合并胃肠功能障碍组患儿血清FGF19水平显著低于未合并胃肠功能障碍组，差异有统计学意义[48.4（27.7，95.6） μg/mL vs 77.6（45.8，151.2） μg/mL，P=0.046]。受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）分析结果显示：FGF19预测儿童脓毒症合并发生胃肠功能障碍的ROC曲线下面积（area under ROC curve，AUC）为0.636（95%CI 0.515～0.757），其效能与降钙素原[AUC=0.683（95%CI 0.562～0.804），P=0.597]相似；入PICU时血清FGF19<60 μg/mL提示患儿发生胃肠功能障碍风险增加。结论·血清FGF19可作为儿童脓毒症合并胃肠功能障碍的新型预测指标。

关键词: 成纤维细胞生长因子19, 胃肠功能障碍, 脓毒症, 儿童

Abstract:

Objective · To assess the potential value of fibroblast growth factor 19 (FGF19) as predictors of gastrointestinal dysfunction in children with sepsis. Methods · A prospective study was conducted, and 101 pediatric patients diagnosed with sepsis and admitted to the pediatric intensive care unit (PICU) at Shanghai Children's Hospital, Shanghai Jiao Tong University were enrolled from January 2018 to December 2018. Eleven cases with missing serum FGF19 were excluded, and 90 cases were analyzed in this study. According to whether gastrointestinal dysfunction occurred in patients with sepsis during PICU hospitalization, patients were divided into two groups, including sepsis-associated gastrointestinal dysfunction group (n=32) and sepsis without gastrointestinal dysfunction group (n=58). Serum FGF19 level was determined on PICU admission. The difference of serum FGF19 levels between the two groups were compared by using Mann-Whitney U test, and multivariate Logistic regression analysis was used to assess the association of FGF19 level with sepsis-associated gastrointestinal dysfunction. Results · The total PICU mortality rate was 12.2% (11/90). There was a tendency for increased PICU mortality in patients with sepsis-associated gastrointestinal dysfunction compared with patients without gastrointestinal dysfunction, but without statistical significance (18.8% vs 8.6%, P=0.160). Serum FGF19 levels were significantly decreased in patients with sepsis-associated gastrointestinal dysfunction compared with patients without gastrointestinal dysfunction [48.4 (27.7, 95.6) μg/mL vs 77.6 (45.8, 151.2) μg/mL, P=0.046]. The results of receiver operating characteristic (ROC) curve analysis showed that the area under ROC curve (AUC) for FGF19 predicting gastrointestinal dysfunction in pediatric patients with sepsis was 0.636 (95%CI 0.515–0.757), which was similar to the predictive capacity of procalcitonin [AUC=0.683 (95%CI 0.562–0.804), P=0.597]. In addition, serum FGF19 levels lower than 60 μg/mL on PICU admission indicated an increased risk of gastrointestinal dysfunction in pediatric patients with sepsis. Conclusion · Serum FGF19 is a novel predictor of gastrointestinal dysfunction in pediatric patients with sepsis.

Key words: fibroblast growth factor 19 (FGF19), gastrointestinal dysfunction, sepsis, child

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