To Investigate Intestinal Barrier Dysfunction And Its Related Factors In Patients With Sepsis

Sepsis is a systemic inflammatory response syndrome caused by infection,which is the serious complications of infection,trauma,shock.It can also cause multiple organ dysfunction syndrome(MODS)and thus lead to the most common cause of death.However,so far,the pathogenesis of sepsis has not yet unclear.The currently accepted mechanism is sepsis is excessive inflammation or uncontrolled inflammation caused by bacteria.The gastrointestinal tract is the body's largest library.Barrier dysfunction can cause bacteria,endotoxin shift,it plays an important role in the development of sepsis.The theory of intestinal sepsis is of concern.The most direct source of evidence for abdominal surgery in patients with sepsis,mesenteric lymph nodes found in intestinal bacteria.However,recent studies have found that intestinal sepsis is not only the beginning,is the victim of sepsis.Sepsis itself can aggravate the injury of intestinal mucosa,intestinal organs are often sepsis complicated with multiple organ dysfunction early involvement.Sepsis itself can aggravate the injury of intestinal mucosa,intestinal organs are often sepsis complicated with multiple organ dysfunction early involvement.The aim of this study was to use a simple,rapid,bedside JY-DLT Intestinal Barrier Functional Biochemical Index Analysis System.To evaluate the relationship between intestinal barrier damage and severity of sepsis in different sepsis patients and to observe the prognosis of sepsis patients,and to explore the mechanism of intestinal barrier injury in sepsis patients,so as to improve the intestinal barrier function in sepsis patients Obstacles provide clinical guidance.Objective To investigate the relationship between related facters of intestinal barrier dysfunctionin patients with sepsis or sepsisshock and severity of the condition.Methods A prospective observational study was conducted in 31 sepsis patients,28 septic shock patient,and 21 postoperative patients without sepsis(control group)who were admitted to intensive care unit(ICU)of General Hospital of Ningxia University between November 2015 and Iune 2016.The patients with sepsis or septic shock were divided into two groups according to the site of infection,i,e.intra-abdominal infection group(n=37)and extra-abdominal infection group(n=22).The patients with sepsis or septic shock were followed up for 28 days after admission to ICU,and advided into survival group(n=44)and death group(n=15).Blood samples were collected from the patients in the fist day following admission to ICU.D-lactic acid and bacterial endotoxin levels were measured by enzymatic method,serum high-sensitivity C-reactive protein(hsCRP)level by immune scatter turbidimetry,PCT.An arterial blood gas(ABG)measurement was carried out every 8 hours in the fist day after admission to ICU,and average arterial blood lactate were calculated.Acute Physiology and Chronic Health Evaluation ?(APACHE ?)score,Sequential Organ Failure Assessment(SOFA)score,mechanical ventilation,length of stay in ICU in the patients in the fist day following ICU admission were recorded.D-lactic acid and bacterial endotoxin levels of the patients with sepsis or septic shock were measured in the third day after admission to ICU again.Results1.Comparison of blood D-lactate acid and bacterial endotoxin levels in the control,sepsis,and septic shock groups(1)Comparison between groups: In the control,sepsis,and septic shock grous at the fist day after admission to ICU,D-lactic acid [mg/L,M(P25,P75)] were 11.68(7.49,14.92),19.78(12.25,34.85),and 32.45(16.03,46.95),respectively;bacterial endotoxin [U/L,M(P25,P75)]were 10.60(7.59,13.39),16.12(10.09,20.23),and 17.31(14.09,23.77),respectively.The levels of D-lactic acid and bacterial endotoxin in patients with sepsis or septic shock were significantly higher than those in the control group(all P<0.01),while no statisticallysignificant differences existed in these two indices between the sepsis and septic shock groups(all P>0.05).In the sepsis and septic shock grous at the third day after admission toICU,D-lacticacid[mg/L,M(P25,P75)]were27.29(16.80,39.86)and34.41(16.57,48.37),respectiv ely;bacteriaendotoxin[U/L,M(P25,P75)]were15.65(12.53,18.93)and19.11(13.88,24.31),respecti vely.The levels of D-lactic acid and bacterial endotoxin in patients with sepsis or septic shock were significantly higher than those in the control group(all P<0.01),and the levels of bacterial endotoxin in patients with sepsis were higher than those in the septic shock group(P<0.05).But The levels of D-lactic acid between the sepsis and septic shock groups were no significant differences(P>0.05).(2)Comparison with the same groups: The sepsis grous at the fist and third day after admission to ICU,D-lactic acid [mg/L,M(P25,P75)] were 15.84(11.47,39.48),and27.29(16.80,39.86),respectively;bacterial endotoxin [U/L,M(P25,P75)] were 18.78(12.00,20.33),and 15.65(12.53,18.93),respectively.The septic shock grous at the fist and third day after admission to ICU,D-lactic acid [mg/L,M(P25,P75)] were33.61(15.54,42.82),and 34.41(16.57,48.37),respectively;bacterial endotoxin [U/L,M(P25,P75)]were 16.03(11.28,21.83),and 19.11(13.88,24.31),respectively.The sepsis and septic shock grous with the D-lactic acid and bacterial comparison with the same groups were no significant differences(all P>0.05).2.Comparison of blood D-lactate acid and bacterial endotoxin levels in the intra-abdominal infection group and extra-abdominal infection group of the patients with sepsis or septic shockIn the first day after admission to ICU,the levers of the D-lactic acid and bacterial endotoxin were in the intra-abdominal infection group(n=37)were 20.07(14.70,38.97)mg/L,17.23(13.38,20.85)U/L;in the extra-abdominal infection group(n=22)were 21.65(14.53,56.56)mg/L,17.17(9.93,20.81)U/L.The levels of D-lactic acid and bacterial endotoxin between above two groups were no significant differences(all P>0.05).In the third day after admission to ICU,the levers of the D-lactic acid and bacterial endotoxin were in the intra-abdominal infection group(n=22)were 31.20(16.44,45.58)mg/L?19.32(13.45,23.46)U/L;in the extra-abdominal infection group(n=11)were 30.77(23.84,47.17)mg/L,15.07(12.22,16.78)U/L.The levels of D-lactic acid and bacterial endotoxin between above two groups were no significant differences(all P>0.05).3.Comparison of blood D-lactate acid and bacterial endotoxin levels in the survival group and death group of the patients with sepsis or septic shockThe levers of the D-lactic acid and bacterial endotoxin were in the survival group(n=44)were 21.65(15.11,39.00)mg/L ? 17.09(12.62,20.42)U/L;in the death group group(n=15)were19.78(14.41,80.93)mg/L?19.26(13.22,26.27)U/L.The levels of D-lactic acid and bacterial endotoxin between above two groups were no significant differences(all P>0.05).4.Correlation annlysis of the D-lactic acid or bacterial endotoxin and other indexes in the patients with sepsis or septic shock(1)In the patients with sepsis or septic shock at the first day after admission to ICU,the D-lactic acid level was significantly related to mean arterial blood lactate,APACHE ?score and SOFA scorer(r=0.50,0.45,0.47,all P<0.05);while it was no related to hsCRP,PCT,mechanical ventilation and length of stay in ICU(all P>0.05).In the patients with sepsis or septic shock at the first day after admission to ICU,the bacterial endotoxin level was related to hsCRP,APACHE ? score and SOFA scorer(r=0.22,0.39,0.39,all P<0.05);while it was no related to mean arterial blood lactate,PCT,ventilation and length of stay in ICU(all P>0.05).(2)Multiple linear regression analysis showed that D-lactic acidlevel was independently associated with average arterial blood lactate concentration as well as SOFA score(R2=0.34,F=19.91,P<0.01),and endotoxin was independently associated with only SOFA score(R2=0.14,F=12.68,P<0.01).Conclusions Patients with sepsis have intestinal barrier injury early,which is correlated with the severity of disease.Tissue hypoperfusion in the early stage of sepsis may be one of the causes of intestinal barrier injury.