肠道屏障功能检测在急性肠梗阻患者诊疗中的临床意义

Clinical significance of intestinal barrier function detection in diagnosis and treatment of acute intestinal obstruction

摘要:

目的 探讨血清二胺氧化酶（DAO）、D-乳酸（D-LC）及细菌内毒素（BT）检测在急性肠梗阻患者诊疗中的临床意义。方法 选取2018年1月—2019年3月在华中科技大学同济医学院附属武汉市中心医院胃肠外科住院治疗的急性肠梗阻患者69例作为研究对象（实验组）。选择同期在该院诊疗的非肠道疾病患者20例作为对照组。根据术中肠管缺血损伤情况，将实验组分为轻损伤组40例和重损伤组29例。测定两组患者的血清DAO、D-LC和BT水平，并比较其手术前后的变化。结果 实验组各时间点血清DAO、D-LC和BT水平比较，差异有统计学意义（P <0.05）；实验组术前2 h、术后第1天和术后第3天血清DAO、D-LC、BT水平较对照组高升高（P <0.05）；术后第7天实验组血清D-LC水平与对照组比较，差异有统计学意义（P <0.05），血清DAO和BT水平与对照组比较，差异无统计学意义（P >0.05）；重损伤组与轻损伤组的DAO、D-LC和BT水平比较，不同时间点有差异（P <0.05），两组间有差异（P <0.05），变化趋势有差异（P <0.05）。结论 血清DAO、D-LC和BT水平在急性肠梗阻患者体内动态变化，可作为急性肠梗阻的辅助诊断指标和病情评估指标，手术前后定期检测在急性肠梗阻诊疗中具有重要的临床意义，值得临床进一步推广应用。

Abstract:

Objective To investigate the value of diamine oxidase (DAO), d-lactic acid (D-LC) and bacterial endotoxin (BT) in diagnosis and assessment of acute intestinal obstruction (AIO).Methods Totally 69 patients diagnosed with AIO between January 2018 and March 2019 in our hospital were choosed as objects of study (group AIO). 20 patients with healthy condition from same period were control group. Based on intraoperative findings and disease severity, group AIO were divided into mild injuries group (40) and severe injuries (29) group. Venous blood from each group and detected the level of serous DAO, D-LC, and BT in 2 hours before operation and 1 day, 3 days, 7 days after operation were collected. The level of serous DAO, D-LC, and BT in each group were compared.Results The level of DAO, D-LC, and BT in peripheral blood of group AIO were significantly higher than those in control group (P < 0.05) in 2 hours before operation and day 1, day 3 after operation. Day 7 after operation, group AIO and control group demonstrated same level. At different time point, the serum level of DAO, D-LC, and BT showed much difference in group AIO (P < 0.05). Compared with mild injuries group, severe injuries group showed the higher level of DAO, D-LC, and BT in 2 hours pre-operation and in day 1, day 3, day 7 post-operation with statistically significant difference (P < 0.05). At different time point, the serum level of DAO, D-LC, and BT showed much difference in severe injuries group and mild injuries group (P < 0.05). Severe injuries group also demonstrated the higher rate of DAO, D-LC, and BT decline in serum than mild injuries group at different time point (all P < 0.05).Conclusion The level of DAO, D-LC, and BT in AIO patients changed dynamically. Monitoring serums DAO, D-LC and BT had certain clinical significance in diagnosis and assessment of AIO..