摘要
目的探讨血清组氨酸脱羧酶(HDC)、D-乳酸盐(D-lactate)及α-谷胱甘肽S-转移酶(α-GST)在肠梗阻患者肠黏膜损伤诊断中的应用价值。方法在治疗前采用酶联免疫吸附试验(ELISA)法检测HDC、D-lactate及α-GST在28例绞窄性肠梗阻患者、19例单纯性肠梗阻患者、17例急性单纯性阑尾炎患者和20例健康自愿者血清中的表达水平,并对其受试者操作特征曲线(ROC)下面积(AUC)进行比较;观察所有患者全身炎症反应综合征(SIRS)和感染(腹腔感染和肺部感染)并发症发生情况,并比较此三种诊断指标在其中的表达差异。结果血清中HDC、D-lactate及α-GST三种指标的表达水平在绞窄性肠梗阻患者中最高(P<0.01),且HDC的AUC为0.913,大于D-lactate的0.872(P=0.000)及α-GST的0.836(P=0.000)。当HDC的临界值为31.00μg/L时,其灵敏度(74.5%)、特异度(94.6%)、假阴性率(25.5%)及假阳性率(5.4%)均优于D-lactate和α-GST。SIRS及腹腔感染发生率在绞窄性肠梗阻患者中明显高于单纯性肠梗阻及急性单纯性阑尾炎患者(P<0.05);而肺部感染发生率在所有患者中差异无统计学意义(P>0.05)。血清HDC在有SIRS和腹腔感染的绞窄性肠梗阻组患者中表达水平均显著高于无SIRS及无腹腔感染患者(P<0.01),血清D-lactate及α-GST在有SIRS的绞窄性肠梗阻患者中表达水平均高于无SIRS患者(P<0.05),而在其余患者中三种指标差异则无统计学意义(P>0.05)。相关性分析发现,HDC、D-lactate和α-GST的表达水平与SIRS及腹腔感染均显著相关(P<0.05),其中HDC与SIRS相关性最高(r=0.608,P=0.001)。结论血清HDC是一种更为有效的诊断肠梗阻患者肠黏膜损伤的生物学指标。
Objective To investigate the clinical values of serum histidine decarboxylase（HDC）,D-lactate,and alpha-glutathione S-transferase（α-GST） for diagnosing intestinal mucosal injury of patients with intestinal obstruction. Methods The expression levels of serum HDC,D-lactate,and α-GST in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy volunteers were determined by enzyme linked immunosorbent assay（ELISA） before the treatment,and then the area under receiver operating characteristic curve（AUC） of these diagnostic indices were compared.In addition,the occurrence rates of systemic inflammatory response syndrome（SIRS） and infectious complications（abdominal cavity infection and pulmonary infection） were closely observed.The relevances of SIRS and infectious complications and the expression levels of these three diagnostic indices were analyzed. Results The expression levels of serum HDC,D-lactate,and α-GST of the patients with strangulated intestinal obstruction were the highest among all the patients（P〈0.01）,and the expression levels of these three indices in the patients with simple intestinal obstruction were higher than those of the patients with acute simple appendicitis（P〈0.05）.The AUC of HDC（0.913） was larger than that of D-lactate（0.872） and α-GST（0.836）（P=0.000,P=0.000,respectively）.When the cut off value of HDC was 31.00 μg/L,the sensitivity,specificity,false negative rate,and false positive rate of HDC were 74.5%,94.6%,25.5%,and 5.4%,respectively,which were all better than those of D-lactate and α-GST.The occurrence rates of SIRS and abdominal cavity infection of the patients with strangulated intestinal obstruction were significantly higher than those of patients with simple intestinal obstruction（P=0.046） and acute simple appendicitis（P=0.027）;while there was not significantly different of pulmonary infection among all the patients（P=0.728）.The expression level of serum HDC in patients with strangulated intestinal obstruction suffered from SIRS（P=0.000） or abdominal cavity infection（P=0.002） was significantly higher than that of not-suffered from SIRS or uninfected patients.Meanwhile,the expression levels of serum D-lactate and α-GST in the patients with strangulated intestinal obstruction suffered from SIRS were higher than those of not-suffered from SIRS patients（P=0.032,P=0.021,respectively）.The expression levels of HDC,D-lactate,and α-GST were significantly correlated with SIRS and abdominal cavity infection（P〈0.05）,among which the level of HDC and the incidence of SIRS had the highest correlation（r=0.608,P=0.001）. Conclusion HDC may be a more effective index for diagnosing intestinal mucosal injury of patients with intestinal obstruction. 更多
出处
《中国普外基础与临床杂志》
CAS
2011年第12期1248-1253,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
黎介寿院士肠道屏障研究专项基金资助项目(项目编号:LJS-2009001)~~
关键词
组氨酸脱羧酶
D-乳酸盐
α-谷胱甘肽S-转移酶
肠梗阻
肠黏膜损伤
Histidine decarboxylase； D-lactate； Alpha-glutathione S-transferase； Intestinal obstruction； Intestinal mucosal injury
