• 上海交通大學(xué)附屬第六人民醫(yī)院普外科（上海 200233）;

目的探討血清組氨酸脫羧酶(HDC)、D-乳酸鹽(D-lactate)及α-谷胱甘肽S-轉(zhuǎn)移酶(α-GST)在腸梗阻患者腸黏膜損傷診斷中的應(yīng)用價(jià)值。方法在治療前采用酶聯(lián)免疫吸附試驗(yàn)(ELISA)法檢測(cè)HDC、Dlactate及αGST在28例絞窄性腸梗阻患者、19例單純性腸梗阻患者、17例急性單純性闌尾炎患者和20例健康自愿者血清中的表達(dá)水平，并對(duì)其受試者操作特征曲線(ROC)下面積(AUC)進(jìn)行比較; 觀察所有患者全身炎癥反應(yīng)綜合征(SIRS)和感染（腹腔感染和肺部感染）并發(fā)癥發(fā)生情況，并比較此三種診斷指標(biāo)在其中的表達(dá)差異。結(jié)果血清中HDC、D-lactate及α-GST三種指標(biāo)的表達(dá)水平在絞窄性腸梗阻患者中最高(P lt;0.01)，且HDC的AUC為0.913，大于D-lactate的0.872(P=0.000)及α-GST的0.836(P=0.000)。當(dāng)HDC的臨界值為31.00 μg/L時(shí)，其靈敏度(74.5%)、特異度(94.6%)、假陰性率(25.5%)及假陽性率(5.4%)均優(yōu)于D-lactate和α-GST。SIRS及腹腔感染發(fā)生率在絞窄性腸梗阻患者中明顯高于單純性腸梗阻及急性單純性闌尾炎患者(P lt;0.05); 而肺部感染發(fā)生率在所有患者中差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。血清HDC在有SIRS和腹腔感染的絞窄性腸梗阻組患者中表達(dá)水平均顯著高于無SIRS及無腹腔感染患者(P lt;0.01)，血清D-lactate及α-GST在有SIRS的絞窄性腸梗阻患者中表達(dá)水平均高于無SIRS患者(P lt;0.05)，而在其余患者中三種指標(biāo)差異則無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。相關(guān)性分析發(fā)現(xiàn)，HDC、D-lactate和α-GST的表達(dá)水平與SIRS及腹腔感染均顯著相關(guān)(P lt;0.05)，其中HDC與SIRS相關(guān)性最高(r=0.608，P=0.001)。結(jié)論血清HDC是一種更為有效的診斷腸梗阻患者腸黏膜損傷的生物學(xué)指標(biāo)。

引用本文： 楊建軍,秦環(huán)龍. 組氨酸脫羧酶、D-乳酸鹽及α-谷胱甘肽S-轉(zhuǎn)移酶在腸梗阻患者腸黏膜損傷診斷中的價(jià)值. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(12): 1248-1253. doi: 復(fù)制

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6. Derikx JP, Matthijsen RA, de Brune AP, et al. Rapid reversal of human intestinal ischemiareperfusion induced damage by shedding of injured enterocytes and reepithelialisation [J]. PLoS One, 2008, 3(10): e3428.
7. 陳雪峰, 何桂珍, 董良廣, 等. 大鼠腸道缺血再灌注損傷時(shí)高遷移率族蛋白1變化及淋巴引流對(duì)腸屏障的保護(hù)作用 [J]. 中華臨床營(yíng)養(yǎng)雜志, 2009, 17(2): 9194.
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9. Gurleyik G, Ozturk E, Gurleyik E, et al. Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction [J]. J Invest Surg, 2003, 16(5): 283288.
10. Chang T, Lu R, Tsai L. Glutamine ameliorates mechanical obstructioninduced intestinal injury [J]. J Surg Res, 2001, 95(2): 133140.
11. 陳國(guó)衛(wèi), 劉玉村. 腸梗阻的手術(shù)適應(yīng)證和剖腹探查 [J]. 中國(guó)實(shí)用外科雜志, 2003, 23(7): 398400.
12. Grotz MR, Deitch EA, Ding J, et al. Intestinal cytokine response after gut ischemia: role of gut barrier failure [J]. Ann Surg, 1999, 229(4): 478486.
13. Faries PL, Simon RJ, Martella AT, et al. Intestinal permeability correlates with severity of injury in trauma patients [J]. J Trauma, 1998, 44(6): 10311035.
14. Bone RC, Balk RA, Cerra FB, et al. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis [J]. Crit Care Med, 1992, 20(6): 864874.
15. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì). 腸屏障功能障礙臨床診治建議 [J]. 中華消化雜志, 2006, 26(9): 620.
16. Murray MJ, Gonze MD, Nowak LR, et al. Serum D()lactate levels as an aid to diagnosing acute intestinal ischemia [J]. Am J Surg, 1994, 167(6): 575578.
17. Assadian A, Assadian O, Senekowitsch C, et al. Plasma Dlactate as a potential early marker for colon ischaemia after open aortic reconstruction [J]. Eur J Vasc Endovasc Surg, 2006, 31(5): 470474.
18. Delaney CP, O’neill S, Manning F, et al. Plasma concentrations of glutathione Stransferase isoenzyme are raised in patients with intestinal ischaemia [J]. Br J Surg, 1999, 86(10): 13491353.
19. Handley SA, Dube PH, Miller VL. Histamine signaling through the H2 receptor in the peyer’s patch is important for controlling yersinia enterocolitica infection [J]. Proc Natl Acad Sci USA, 2006, 103(24): 92689273.
20. Kahlson G, Rosengren E. New approaches to the physiology of histamine [J]. Physiol Rev, 1968, 48(1): 155196.
21. Fujimoto K, Imamura I, Granger DN, et al. Histamine and histidine decarboxylase are correlated with mucosal repair in rat small intestine after ischemiareperfusion [J]. J Clin Invest, 1992, 89(1): 126133.
22. Mei Q, Sundler F. Local downregulation of enterochromaffinlike cell histamine formation in ulcer healing: a study in rats [J]. Digestion, 1999, 60(3): 227237.
23. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve [J]. Am J Epidemiol, 2006, 163(7): 670675.
  1. 1. Rahman SH, Ammori BJ, Holmfield J, et al. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis [J]. J Gastrointest Surg, 2003, 7(1): 2635.
  2. 2. Zhang X, Chen L, Luo L, et al. Study of the protective effects of dexamethasone on ileum mucosa injury in rats with severe acute pancreatitis [J]. Pancreas, 2008, 37(3): e74e82.
  3. 3. 劉中輝, 杜艷平, 李初俊, 等. 生態(tài)免疫腸內(nèi)營(yíng)養(yǎng)對(duì)重癥胰腺炎大鼠腸屏障功能和胰腺炎癥的影響 [J]. 中華臨床營(yíng)養(yǎng)雜志, 2010, 18(2): 106110.
  4. 4. de Haan JJ, Lubbers T, Derikx JP, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study [J]. Crit Care, 2009, 13(3): R86.
  5. 5. Jin W, Wang HD, Hu ZG, et al. Transcription factor Nrf2 plays a pivotal role in protection against traumatic brain injuryinduced acute intestinal mucosal injury in mice [J]. J Surg Res, 2009, 157(2): 251260.
  6. 6. Derikx JP, Matthijsen RA, de Brune AP, et al. Rapid reversal of human intestinal ischemiareperfusion induced damage by shedding of injured enterocytes and reepithelialisation [J]. PLoS One, 2008, 3(10): e3428.
  7. 7. 陳雪峰, 何桂珍, 董良廣, 等. 大鼠腸道缺血再灌注損傷時(shí)高遷移率族蛋白1變化及淋巴引流對(duì)腸屏障的保護(hù)作用 [J]. 中華臨床營(yíng)養(yǎng)雜志, 2009, 17(2): 9194.
  8. 8. Guan Y, Worrell RT, Pritts TA, et al. Intestinal ischemiareperfusion injury: reversible and irreversible damage imaged in vivo [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(1): G187G196.
  9. 9. Gurleyik G, Ozturk E, Gurleyik E, et al. Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction [J]. J Invest Surg, 2003, 16(5): 283288.
  10. 10. Chang T, Lu R, Tsai L. Glutamine ameliorates mechanical obstructioninduced intestinal injury [J]. J Surg Res, 2001, 95(2): 133140.
  11. 11. 陳國(guó)衛(wèi), 劉玉村. 腸梗阻的手術(shù)適應(yīng)證和剖腹探查 [J]. 中國(guó)實(shí)用外科雜志, 2003, 23(7): 398400.
  12. 12. Grotz MR, Deitch EA, Ding J, et al. Intestinal cytokine response after gut ischemia: role of gut barrier failure [J]. Ann Surg, 1999, 229(4): 478486.
  13. 13. Faries PL, Simon RJ, Martella AT, et al. Intestinal permeability correlates with severity of injury in trauma patients [J]. J Trauma, 1998, 44(6): 10311035.
  14. 14. Bone RC, Balk RA, Cerra FB, et al. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis [J]. Crit Care Med, 1992, 20(6): 864874.
  15. 15. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì). 腸屏障功能障礙臨床診治建議 [J]. 中華消化雜志, 2006, 26(9): 620.
  16. 16. Murray MJ, Gonze MD, Nowak LR, et al. Serum D()lactate levels as an aid to diagnosing acute intestinal ischemia [J]. Am J Surg, 1994, 167(6): 575578.
  17. 17. Assadian A, Assadian O, Senekowitsch C, et al. Plasma Dlactate as a potential early marker for colon ischaemia after open aortic reconstruction [J]. Eur J Vasc Endovasc Surg, 2006, 31(5): 470474.
  18. 18. Delaney CP, O’neill S, Manning F, et al. Plasma concentrations of glutathione Stransferase isoenzyme are raised in patients with intestinal ischaemia [J]. Br J Surg, 1999, 86(10): 13491353.
  19. 19. Handley SA, Dube PH, Miller VL. Histamine signaling through the H2 receptor in the peyer’s patch is important for controlling yersinia enterocolitica infection [J]. Proc Natl Acad Sci USA, 2006, 103(24): 92689273.
  20. 20. Kahlson G, Rosengren E. New approaches to the physiology of histamine [J]. Physiol Rev, 1968, 48(1): 155196.
  21. 21. Fujimoto K, Imamura I, Granger DN, et al. Histamine and histidine decarboxylase are correlated with mucosal repair in rat small intestine after ischemiareperfusion [J]. J Clin Invest, 1992, 89(1): 126133.
  22. 22. Mei Q, Sundler F. Local downregulation of enterochromaffinlike cell histamine formation in ulcer healing: a study in rats [J]. Digestion, 1999, 60(3): 227237.
  23. 23. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve [J]. Am J Epidemiol, 2006, 163(7): 670675.