降钙素原联合肠型脂肪酸结合蛋白对肠结核并发肠道穿孔的诊断价值

doi:10.3969/j.issn.1673-8640.2026.10.008

摘要/Abstract

摘要：

目的探讨降钙素原（PCT）和肠型脂肪酸结合蛋白（I-FABP）联合检测诊断肠结核并发肠道穿孔的价值。方法选取2020年1月—2024年12月青海省第四人民医院肠结核患者123例、健康体检者100名（正常对照组）。根据是否并发肠道穿孔将肠结核患者分为穿孔组（43例）和未穿孔组（80例）。收集所有研究对象的临床资料，并检测血清PCT、I-FABP水平。采用Spearman相关分析评估PCT、I-FABP水平与病情严重程度的相关性。采用多因素Logistic回归分析评估肠结核并发肠道穿孔的影响因素。采用受试者工作特征（ROC）曲线评价各项指标单项检测和联合检测诊断肠结核并发肠道穿孔的效能。结果穿孔组血清PCT、I-FABP水平显著高于未穿孔组和正常对照组（P<0.05），未穿孔组血清PCT、I-FABP水平显著高于正常对照组（P<0.05）。血清PCT、I-FABP与肠结核并发肠道穿孔患者病情严重程度呈正相关（r_s值分别为0.699、0.745，P<0.001），PCT与I-FABP亦呈正相关（r=0.513，P<0.001）。发热、腹痛和白细胞（WBC）计数、PCT、I-FABP升高均是肠结核患者并发肠道穿孔的独立危险因素（P<0.05）。血清PCT、I-FABP单项检测和联合检测诊断肠结核并发肠道穿孔的曲线下面积（AUC）分别为0.875、0.776、0.933。结论血清PCT和I-FABP联合检测可有效提高肠结核并发肠道穿孔的诊断准确性，且与病情严重程度密切相关，或可作为肠结核并发肠道穿孔诊断和病情评估的有效指标。

关键词: 降钙素原, 肠型脂肪酸结合蛋白, 肠结核, 肠道穿孔

Abstract:

Objective To evaluate the diagnostic value of combined determination of procalcitonin（PCT） and intestinal fatty acid-binding protein（I-FABP） in intestinal tuberculosis complicated with intestinal perforation. Methods A total of 123 patients with intestinal tuberculosis and 100 healthy subjects（healthy control group） were enrolled from the 4th People's Hospital of Qinghai Province between January 2020 and December 2024. Intestinal tuberculosis patients were classified into perforation group（43 cases） and non-perforation group（80 cases）. The clinical data were collected，and serum levels of PCT，I-FABP were determined. Spearman correlation analysis was used to assess the relationship between PCT，I-FABP levels and disease severity. Multivariate Logistic regression analysis was performed to identify factors for intestinal perforation in intestinal tuberculosis. Receiver operating characteristic（ROC） curves were used to evaluate the diagnostic performance of single and combined determinations for intestinal perforation in intestinal tuberculosis. Results Serum PCT and I-FABP levels were higher in perforation group than those in both non-perforation group and healthy control group（P<0.05），while the levels in non-perforation group were higher than those in healthy control group（P<0.05）. Serum PCT and I-FABP levels showed positive correlations with disease severity in patients with intestinal tuberculosis complicated by intestinal perforation（r_s=0.699 and 0.745，respectively，P<0.001），and PCT was also positively correlated with I-FABP（r=0.513，P<0.001）. Fever，abdominal pain，elevated white blood cell（WBC） count，PCT and I-FABP levels were all independent risk factors for intestinal tuberculosis complicated by intestinal perforation（P<0.05）. The areas under curves（AUC） for serum PCT，I-FABP and their combined determination in diagnosing intestinal tuberculosis complicated by intestinal perforation were 0.875，0.776 and 0.933，respectively. Conclusions The combined determination of serum PCT and I-FABP can effectively improve the diagnostic accuracy of intestinal perforation in intestinal tuberculosis and is associated with disease severity，suggesting that these markers may serve as effective indicators for diagnosis and assessment of disease progression.

Key words: Procalcitonin, Intestinal fatty acid-binding protein, Intestinal tuberculosis, Intestinal perforation

中图分类号:

R446.1

冶成贵, 严兆兰, 魏国月. 降钙素原联合肠型脂肪酸结合蛋白对肠结核并发肠道穿孔的诊断价值[J]. 检验医学, 2026, 41(10): 980-985.

YE Chenggui, YAN Zhaolan, WEI Guoyue. Diagnostic value of procalcitonin combined with intestinal fatty acid-binding protein in the diagnosis of intestinal perforation associated with intestinal tuberculosis[J]. Laboratory Medicine, 2026, 41(10): 980-985.

图/表 5

参考文献 21

[1]	Vargas Rodríguez A E, Godinez Vidal A R, Alcántara Gordillo R, et al. A case report and literature review of intestinal perforation due to tuberculosis[J]. Cureus, 2023, 15(8):e43241.
[2]	Huang P, Luo N, Shi X, et al. Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation[J]. BMC Pediatr, 2024, 24(1):143. DOI PMID
[3]	王双. 结肠穿孔所致腹腔感染患者腹水病原菌分布及死亡因素分析[J]. 中国肛肠病杂志, 2025, 45(1):29-32.
[4]	李枫林, 孙金华, 孙媛媛, 等. 微生态制剂联合膳食纤维对慢性阻塞性肺疾病及肠道菌群和炎症因子的影响[J]. 实用临床医药杂志, 2025, 29(2):90-95.
[5]	中国疾病预防控制中心结核病预防控制中心. 中国结核病防治工作技术指南[M]. 北京: 人民卫生出版社, 2021.
[6]	荆申奥, 马蓉蓉, 张瑞, 等. 基于常见不良事件评价标准的药物不良反应严重程度再评估[J]. 药物不良反应杂志, 2025, 27(12):745-751.
[7]	陈建勇, 陈杰, 王爱瑶, 等. 肠结核实验室诊断技术的研究进展[J]. 江西医药, 2024, 59(8):707-709.
[8]	Xu K, Tan J, Lin D, et al. Gut microbes of the cecum versus the colon drive more severe lethality and multi-organ damage[J]. Int Immunopharmacol, 2025, 147:114029. DOI URL
[9]	Ahmed S, Hafez W, El Chayeb J, et al. Intestinal tuberculosis and inflammatory bowel disease; the usual challenging differential diagnoses:a case report[J]. Radiol Case Rep, 2023, 18(10):3680-3685. DOI URL
[10]	He R R, Yue G L, Dong M L, et al. Sepsis biomarkers:advancements and clinical applications-a narrative review[J]. Int J Mol Sci, 2024, 25(16):9010. DOI URL
[11]	Varkila M R J, Verboom D M, Derde L P G, et al. Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case-control study[J]. Ann Intensive Care, 2024, 14(1):42. DOI PMID
[12]	Liu S, Liu Y, Lai S, et al. Values of serum intestinal fatty acid-binding protein,fecal calprotectin,and fecal human β-defensin 2 for predicting necrotizing enterocolitis[J]. BMC Pediatr, 2024, 24(1):183. DOI
[13]	Randeni N, Bordiga M, Xu B. A comprehensive review of the triangular relationship among diet-gut microbiota-inflammation[J]. Int J Mol Sci, 2024, 25(17):9366. DOI URL
[14]	Qiu P, Wu C, Zhang X, et al. Towards building multilingual language model for medicine[J]. Nat Commun, 2024, 15(1):8384. DOI PMID
[15]	Chen L, Chen X. The role of different systemic inflammatory indexes derived from complete blood count in differentiating acute from chronic calculus cholecystitis and predicting its severity[J]. J Inflamm Res, 2024, 17:2051-2062. DOI PMID
[16]	Xiangyuan C, Xiaoling Z, Guangchao S, et al. Juvenile dermatomyositis complications:navigating gastrointestinal perforations and treatment challenges,a case report[J]. Front Pediatr, 2024, 12:1419355. DOI URL
[17]	Un Nisa Z, Ambreen A, Mustafa T. Persistently high plasma procalcitonin levels despite successful treatment of tuberculous pleuritis and tuberculous lymphadenitis patients[J]. Sci Rep, 2024, 14(1):22590. DOI PMID
[18]	Gaffar S, Aathirah A S. Fatty-acid-binding proteins:from lipid transporters to disease biomarkers[J]. Biomolecules, 2023, 13(12):1753. DOI URL
[19]	Chen J, Yan Z, Lin Z, et al. I-FABP protein/mRNA and IL-6 as biomarkers of intestinal barrier dysfunction in neonates with necrotizing enterocolitis and SPF BALB/cmouse models[J]. J Int Med Res, 2024, 52(6):3000605241254788. DOI URL
[20]	吕颜智, 周业江. 血清降钙素原对急性消化道穿孔部位的预测价值[J]. 中华急诊医学杂志, 2021, 30(11):1353-1357.
[21]	Wu J, Shu P, He H, et al. Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery:a single-centre retrospective cohort study[J]. Gastroenterol Rep(Oxf), 2021,10:goab054.

组别	例数	年龄/岁	性别		BMI/ （kg·m^-2）	发热/ [例（%）]	腹痛/ [例（%）]	吸烟史/ [例（%）]
组别	例数	年龄/岁	男[例（%）]	女[例（%）]	BMI/ （kg·m^-2）	发热/ [例（%）]	腹痛/ [例（%）]	吸烟史/ [例（%）]
穿孔组	43	58.32±5.51	25（58.14）	18（41.86）	20.81±3.12	38（88.37）	14.22±4.51	22（51.16）
未穿孔组	80	56.73±5.82	42（52.50）	38（47.50）	22.35±2.90	45（56.25）	9.14±3.34	35（43.75）
统计值		1.472	0.359		2.735	13.150	7.094	0.618
P值		0.144	0.549		0.007	<0.001	<0.001	0.432
组别	饮酒史/ [例（%）]		高血压史/ [例（%）]		糖尿病史/ [例（%）]	WBC计数/ （×10⁹L^－1）	CRP/ （mg·L^－1）	IL-6/ （pg·mL^－1）
穿孔组	15（34.88）		18（41.86）		12（27.91）	14.22±4.51	15.34±3.97	29.05±6.24
未穿孔组	32（40.00）		30（37.50）		20（25.00）	9.14±3.34	13.97±3.86	26.82±6.15
统计值	0.310		0.224		3.025	7.094	1.858	1.908
P值	0.578		0.636		0.082	<0.001	0.066	0.059

组别	例数	年龄/岁	性别		BMI/ （kg·m^-2）	发热/ [例（%）]	腹痛/ [例（%）]	吸烟史/ [例（%）]
组别	例数	年龄/岁	男[例（%）]	女[例（%）]	BMI/ （kg·m^-2）	发热/ [例（%）]	腹痛/ [例（%）]	吸烟史/ [例（%）]
穿孔组	43	58.32±5.51	25（58.14）	18（41.86）	20.81±3.12	38（88.37）	14.22±4.51	22（51.16）
未穿孔组	80	56.73±5.82	42（52.50）	38（47.50）	22.35±2.90	45（56.25）	9.14±3.34	35（43.75）
统计值		1.472	0.359		2.735	13.150	7.094	0.618
P值		0.144	0.549		0.007	<0.001	<0.001	0.432
组别	饮酒史/ [例（%）]		高血压史/ [例（%）]		糖尿病史/ [例（%）]	WBC计数/ （×10⁹L^－1）	CRP/ （mg·L^－1）	IL-6/ （pg·mL^－1）
穿孔组	15（34.88）		18（41.86）		12（27.91）	14.22±4.51	15.34±3.97	29.05±6.24
未穿孔组	32（40.00）		30（37.50）		20（25.00）	9.14±3.34	13.97±3.86	26.82±6.15
统计值	0.310		0.224		3.025	7.094	1.858	1.908
P值	0.578		0.636		0.082	<0.001	0.066	0.059

指标	例数	PCT/（ng·mL^－1）	I-FABP/ （ng·mL^－1）
正常对照组	100	0.13±0.04	4.26±1.29
未穿孔组	80	0.48±0.23^*	12.61±6.33^*
穿孔组	43	2.86±1.72^*#	38.05±13.72^*#
F值		201.440	970.267
P值		<0.001	<0.001

指标	例数	PCT/（ng·mL^－1）	I-FABP/ （ng·mL^－1）
正常对照组	100	0.13±0.04	4.26±1.29
未穿孔组	80	0.48±0.23^*	12.61±6.33^*
穿孔组	43	2.86±1.72^*#	38.05±13.72^*#
F值		201.440	970.267
P值		<0.001	<0.001

项目	β值	标准误	Wald值	P值	OR^①值（95%CI^②）
BMI	-0.125	0.078	2.563	0.109	0.883（0.762~1.022）
发热	1.234	0.456	7.321	0.007	3.435（1.452~8.147）
腹痛	0.852	0.376	5.381	0.020	2.392（1.145~4.998）
WBC计数	0.098	0.034	8.294	0.004	1.103（1.031~1.180）
PCT	0.215	0.089	5.842	0.016	1.240（1.042~1.475）
I-FABP	0.321	0.123	6.945	0.009	1.379（1.087~1.752）