结肠术后患者肠道通透性及炎症反应的观察

Intestinal permeability and inflammatory response following colonic surgery

目的观察结肠手术后患者肠道通透性及炎症反应,探讨肠黏膜通透性(乳果糖/甘露醇比值L/M)、APCHEⅡ评分、白介素-6(IL-6)、白细胞(WBC)计数与外周血中大肠杆菌DNA阳性率的关系。方法2005年2月至2006年6月我科收治的结肠癌行手术患者48例,检测术前和术后第3天、第7天的L/M比值、APCHEⅡ评分、IL-6、WBC数和外周血中大肠杆菌DNA,并根据外周血大肠杆菌DNA的PCR阴、阳性分组行各指标的比较。结果术后第3天的尿L/M比值、APACHEⅡ评分、IL-6、WBC数均较术前和术后第7天为高,差异有统计学意义(P<0.01);术后第7天的尿L/M比值、IL-6、WBC数均高于术前,差异有统计学意义(P<0.01)。PCR阳性(例次)组的L/M比值、APACHEⅡ评分、IL-6、WBC数高于与PCR阴性(例次)组,差异有统计学意义(P<0.01)。结论结肠手术后第3天肠黏膜通透性增加,炎症反应明显;细菌易位与肠黏膜通透性和炎症反应有关。

Objective To observe the intestinal permeability and inflammatory response after colonic surgery, and to study the relationship of intestinal permeability, serum IL-6 level, APACHE Ⅱ score and WBC count to the percentage of Escherichia coli （EC） DNA from peripheral blood. Methods Forty-eight patients with colon carcinoma underwent colonic surgery from February 2005 to June 2006. The ratio of urinary lactulose to mannitol （L/M）, serum IL-6 level, APACHE Ⅱ score, WBC count and EC DNA from peripheral blood were determined before surgery and on the 3rd and 7th postoperative day （POD）. Results L/M ratio, serum IL-6 level, APACHE Ⅱ score, and WBC oount on the 3rd POD were superior to those before surgery and on the 7th POD （P 〈 0.01 ）, and so did in EC DNA positive patients as compared with EC DNA negative subjects （P 〈 0.01）. Conclusion The intestinal permeability and inflammatory response are evident on the 3rd POD, which is related to the bacterial colonization.