组氨酸脱羧酶、肠脂肪酸结合蛋白和二胺氧化酶在肠梗阻患者肠黏膜损伤诊断中的价值

Values of histidine decarboxylase, intestinal fatty acid binding protein, and diamine oxidase for diagnosing intestinal mucosal injury in patients with intestinal obstruction

目的 探讨血清组氨酸脱羧酶（HDC）、肠脂肪酸结合蛋白（I-FABP）和二胺氧化酶（DAO）在肠梗阻患者肠黏膜损伤（IMI）诊断中的应用价值。方法采用酶联免疫吸附法检测HDC、I-FABP和DAO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治疗前和20名健康对照者血清中的表达水平，并对其受试者工作特征（ROC）曲线下面积（AUC）进行比较；观察3组患者全身炎症反应综合征（SIRS）和感染并发症发生情况，并比较各诊断指标在其中的表达差异及与SIRS和感染并发症的相关性。结果血清中HDC、I-FABP和DAO的表达水平均在绞窄性肠梗阻组中最高，明显高于其他3组（P均〈0．001），3种指标的表达水平在单纯性肠梗阻组亦明显高于急性单纯性阑尾炎组和正常对照组（P均〈0．05）。HDC的AUC为0．913，大于I-FABP及DAO的0．877（P：0．000）和0．873（P=0．000）。当HDC的临界值≥31．00ng／ml时，其灵敏度为74．5％，特异度为94．6％，假阴性率为25．5％，假阳性率为5．4％，均优于I-FABP和DAO。绞窄性肠梗阻组、单纯性肠梗阻组及急性单纯性阑尾炎组的SIRS（P=0．046）和腹腔感染（P=0．027）发生率差异有统计学意义，而肺部感染发生率在3组患者中差异无统计学意义（P=0．728）。血清HDC在绞窄性肠梗阻组的SIRS（P=0．000）和腹腔感染（P=0．002）患者中表达水平均显著高于未感染患者，血清I-FABP（P=0．027）及DAO（P=0．017）在绞窄性肠梗阻组的SIRS患者中表达水平均高于未感染患者。HDC、I-FABP及DAO的表达水平与SIRS及腹腔感染显著相关（P均〈0．05），其中HDC与SIRS相关性最高（R=0．608，P=0．001）。结论血清HDC是一种有效的诊断肠梗阻患者IMI的生物学指标。

Objective To investigate the clinical values of serum histidine decarboxylase （ HDC）, intestinal fatty acid binding protein （ I-FABP）, and diamine oxidase （ DAO ） for diagnosing intestinal mucosal injury （IMI） in patients with intestinal obstruction. Methods The expression levels of serum HDC, I-FABP, and DAO in 28 patients with strangulated intestinal obstruction, 19 patients with simple intestinal obstruction, 17 patients with acute simple appendicitis, and 20 healthy controls were determined by enzyme-linked immunosorbent assay （ELISA） before clinical treatment, and then the areas under receiver operating characteristic curves （AUC） of these diagnostic indicators were compared. In addition, the incidences of systemic inflammatory response syndrome （SIRS） and infectious complications were closely observed. The difference of the expressions of HDC, I-FABP, and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls. Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction （ all P 〈 0. 001 ）, and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls （ all P 〈 0. 05）. The AUC of HDC （0. 913 ） was significantly larger than that of I-FABP （0. 877, P = 0. 000 ） and DAO （0. 873, P = 0. 000）. When the cut-off value of HDC t〉 31.00 ng/ml, 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 I-FABP and DAO. There were significant differences of the incidence of SIRS （P = 0. 046） and abdominal infection （P = 0. 027 ） among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference （P = 0. 728 ）. The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS （ P = 0. 000 ） or abdominal infection （ P = 0. 002 ） than that of uninfected patients. Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients （ P = 0. 027, P = 0. 017, respectively）. The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection （ all P 〈 0. 05 ） , among which the level of HDC and the inci- dence of SIRS had the highest correlation （R = 0. 608, P = 0. 001 ）. Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.