血清二胺氧化酶、D-乳酸和细菌内毒素在重症患者肠道功能评估中的作用

Clinical significances of plasma diamineoxidase,D-lactate and endotoxin activity in critical ill patient with gastrointestinal dysfunction

目的探讨血清二胺氧化酶(DAO)、D-乳酸(DLC)和细菌内毒素(BT)水平在ICU重症患者中的变化及其在肠道功能和病情评估中的临床意义。方法对117例患者在入科24小时内进行APACHEⅡ评分,采用二胺氧化酶/乳酸/细菌内毒素联检试剂盒(酶法)定量检测人体血清中二胺氧化酶、D-乳酸和细菌内毒素的活性,分析ICU重症患者二胺氧化酶、D-乳酸和细菌内毒素的变化及其与APACHEⅡ评分的关系。结果根据患者是否存在胃肠功能障碍将ICU重症患者分为非胃肠功能障碍组和胃肠功能障碍组。非胃肠功能障碍组与胃肠功能障碍组的血清二胺氧化酶水平分别为6.33±9.55 U/L、16.46±22.60 U/L,两组比较,差异有统计学意义(P=0.01),D-乳酸水平分别为11.66±12.36 mg/L、24.32±16.49 mg/L,两组比较,差异有统计学意义(P<0.001),细菌内毒素水平分别为9.34±10.17 U/L、11.43±9.70 U/L,两组比较,差异有统计学意义(P=0.04);患者二胺氧化酶、D-乳酸、细菌内毒素水平和APACHE II评分呈显著正相关,二胺氧化酶与APACHE II评分:r=0.427,P=0.01,D-乳酸与APACHEⅡ评分:r=0.53,P<0.001,细菌内毒素水平与APACHE II评分:r=0.451,P<0.001。结论 ICU胃肠功能障碍的重症患者血清二胺氧化酶、D-乳酸和细菌内毒素水平显著升高,二胺氧化酶、D-乳酸、细菌内毒素水平和患者APACHE II评分呈显著正相关。监测血二胺氧化酶、D-乳酸和细菌内毒素活性可作为评估ICU重症患者胃肠功能障碍的重要指标及评估病情严重程度的指标之一。

Objective To investigate the value of diamineoxidase,D-lactic and endotoxin in critical illness with gastrointestinal dysfunction. Methods 117 patients admitted to ICU were quantitatively detected serum diamineoxidase,D-lactic and endotoxin by using diamineoxidase/lactic/endotoxin inspection Kit,and calculated the first 24 h Acute Physiology And Chronic Health EvaluationⅡ（APACHE Ⅱ）. The gastrointestinal function of patients was evaluated firstly,and according to whether patients presented gastrointestinal dysfunction,117 patients were assigned to two group：non-gastrointestinal dysfunction group and gastrointestinal dysfunction group. Results Plasma diamineoxidase level were markedly increased in gastrointestinal dysfunction group（16.46±22.60 U/L）as compare with non-gastrointestinal dysfunction group（6.33±9.55 U/L,P=0.01）. Serum D-lactate levels were markedly increased in gastrointestinal dysfunction group（24.32±16.49mg/L）as compare with non-gastrointestinal dysfunction group（11.66±12.36 mg/L,P〈0.01）. Serum endotoxin levels were higher in gastrointestinal dysfunction group（11.43 ± 9.70U/L） than in non-gastrointestinal dysfunction group（9.34± 0.17 U/L,P=0.04）. Diamineoxidase,D-lactic and endotoxin levels were positively correlated with APACHE II scores：r=0.427,P=0.01,r=0.53,P〈0.001,and r=0.451,P〈0.001,respectively.Conclusion Diamineoxidase,D-lactic and endotoxin levels were significant increasing in patients with severe gastrointestinal dysfunction and were positively correlated with APACHE and II scores. It suggests the serum diamineoxidase,D-lactic and endotoxin can be used to evaluate gastrointestinal dysfunction as well as the severity in critically ill patients.