肠道屏障功能障碍:治疗急性Stanford A型主动脉夹层全身炎性反应的新靶点

Intestinal Barrier Dysfunction:A Novel Therapeutic Target for Inflammatory Response in Acute Stanford Type A Aortic Dissection

目的探讨急性Stanford A型主动脉夹层(ATAAD)患者中是否存在肠道屏障功能障碍,并分析其损伤程度与炎症水平之间的相关性。方法选取2013年8月至2014年8月于四川大学华西医院就诊的75例ATAAD患者及门诊体检中心的50例健康人的血清标本进行前瞻性分析。通过比色法测定血清中二胺氧化酶(DAO)、乳酸脱氢酶(LDH)的活性;利用酶联免疫吸附法及免疫比浊法分别测定白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及C反应蛋白(CRP)的表达水平;通过Pearson分析DAO与TNF-α、IL-6和CRP之间的相关程度。结果 ATAAD组DAO、LDH、IL-6、TNF-α及CRP的表达水平明显高于对照组(P<0.05)。DAO的活性与IL-6(r=0.682,P<0.001)、TNF-α(r=0.696,P<0.001)及CRP(r=0.519,P<0.001)表达水平存在明显正相关性。此外,DAO的活性与氧合指数(OI)存在负相关性(r=-0.397,P<0.001)。结论血清DAO活性升高可反映肠道屏障功能障碍,其可能是ATAAD患者合并全身性炎症反应的重要机制。

Objective To investigate whether intestinal barrier dysfunction occurs in patients with acute Stanford type A aortic dissection（ATAAD）,and to determine the potential relationship between its degree of injury and levels of inflammation.Methods Serum samples from a total of 75 patients with ATAAD and 50 healthy volunteers were prospectively collected and analyzed.Colorimetric assay was used to measure the serum levels of diamine oxidase（DAO）,lactate dehydrogenase（LDH）,and enzyme linked immunosorbent assay（ELISA）and immuno-turbidimetric assay were used to measure interleukin-6,tumor necrosis factor-α（TNF-α）and C-reactive protein（CRP）.Degree of correlation between DAO and TNF-α,IL-6and CRP were analyzed via pearson.Results Serum levels of DAO,LDH,IL-6,TNF-αand CRP in patients with ATAAD were significantly higher than those in healthy controls（P〈0.05）.A significantly positive correlation between DAO activity and interleukin-6（r=0.682,P〈0.001）,tumor necrosis factor-α（r=0.696,P〈0.001）,and C-reactive protein（r=0.519,P〈0.001）was observed.Moreover,the activity of DAO correlated negatively with oxygenation index（OI）（r=-0.397,P〈0.001）.Conclusion Intestinal barrier dysfunction,reflected by an increased level of serum DAO,may play an important role in the development of systemic inflammatory responses in patients with ATAAD.