Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery
Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery
复制标题
筛选和组合血清生物标志物以提高其在腹部大手术后患者肠屏障功能障碍检测中的诊断性能
DOI：
10.21037/atm.2019.07.102
复制
发表时间：
2019-08-01
影响因子：
--
通讯作者：
Xu, Peng-Yuan
中科院分区：
文献类型：
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作者：
Kong, Can;Li, Shu-Min;Xu, Peng-Yuan
背景资料：本前瞻性研究的目的是筛选和联合收割机有效的生物标志物，以提高其诊断性能，在检测肠道屏障功能障碍的患者后，腹部大surgery.Methods：接受腹部大手术的患者在签署知情同意书后，在这项研究中被纳入。分别于术前、术后24 h检测血清α-GST、DAO、D-乳酸、瓜氨酸和I-FABP浓度。使用逻辑回归模型和受试者工作特征（ROC）曲线分析评估了五种生物标志物对肠道屏障功能障碍的诊断性能。结果：39名腹部大手术患者入组并成功完成了本研究。ROC分析显示，D-乳酸、瓜氨酸和I-FABP的敏感性非常高（分别为0.91、0.91和1.00），但这些生物标志物的特异性小于0.70。DAO的敏感性很低[0.25; 95%可信区间（CI），0.05-0.57]，但其特异性很高（0.92; 95% CI，0.75-0.99）。D-乳酸和I-FABP的准确性非常高，生物标志物的曲线下面积（AUC）分别为0.84（95%CI，0.68-0.93）和0.81（95%CI，0.65-0.92）。还分析了五种生物标志物的不同组合。I-FABP、瓜氨酸和D-乳酸联合检测的敏感性、特异性和AUC值分别为1.00、0.74和0.89。结论：联合检测血清D-乳酸、瓜氨酸和I-FABP可显著提高腹部大手术后肠屏障功能障碍的诊断能力。
Background: The aim of this prospective study was to screen and combine effective biomarkers to improve their diagnostic performance in detecting intestinal barrier dysfunction in patients after major abdominal surgery.Methods: Patients undergoing major abdominal surgery were enrolled after signing informed consent in this study. The serum concentrations of alpha-GST, DAO, D-lactate, citrulline and I-FABP were detected 24 hours before and after surgery. The diagnostic performance of five biomarkers on intestinal barrier dysfunction was assessed using logistic regression models and receiver operating characteristic (ROC) curve analyses.Results: Thirty-nine patients with major abdominal surgery were enrolled in and successfully completed this study. ROC analysis revealed that the sensitivities of D-lactate, citrulline and I-FABP were very high (0.91, 0.91 and 1.00, respectively), but the specificities of these biomarkers were less than 0.70. The sensitivity of DAO was very low [0.25; 95% confidence interval (CI), 0.05-0.57], but its specificity was high (0.92; 95% CI, 0.75-0.99). The accuracies of D-lactate and I-FABP were very high, and the areas under the curves (AUCs) of the biomarkers were 0.84 (95% CI, 0.68-0.93) and 0.81 (95% CI, 0.65-0.92), respectively. Different combinations of five biomarkers were also analysed. The sensitivity, specificity and AUC values of the combination of I-FABP, citrulline and D-lactate were 1.00, 0.74 and 0.89, respectively. These results were similar to those derived from the combination of alpha-GST, DAO, D-lactate, citrulline and I-FABP (P=1.000).Conclusions: The combination of serum D-lactic acid, citrulline and I-FABP greatly improved the diagnostic performance for identifying intestinal barrier dysfunction in patients after major abdominal surgery.