血清D-乳酸、细菌内毒素及二胺氧化酶在创伤性颅脑损伤后肠道黏膜屏障功能评估中的作用

Clinical roles of plasma D-lactate,endotoxin and diamineoxidase in assessment of intestinal mucosal barrier function post traumatic brain injury

目的探讨血清中D-乳酸、细菌内毒素及二胺氧化酶的水平在评估创伤性颅脑损伤(TBI)患者肠道黏膜屏障功能中的作用。方法回顾性纳入2017年1月至2018年8月中国人民解放军联勤保障部队第九○四医院神经外科收治的70例TBI患者(TBI组),同时纳入同期该院体检中心的45例健康志愿者作为对照(健康对照组)。所有TBI患者均行药物或手术治疗。取患者和健康者的外周血以检测血清中D-乳酸、细菌内毒素及二胺氧化酶的水平。进一步采用Spearman相关分析方法判断TBI患者治疗前血清中D-乳酸、细菌内毒素及二胺氧化酶与格拉斯哥昏迷评分(GCS)之间的相关性。结果与健康对照组比较,TBI组患者的血清中D-乳酸[(24.7±9.4)mg/L、(9.8±4.0)mg/L]、细菌内毒素[(9.1±5.8)U/L、(4.0±2.2)U/L]及二胺氧化酶[分别为(36.3±22.6)U/L、(15.2±3.6)U/L]的水平均显著升高(t值分别为9.82、2.84、3.49,均P<0.05)。进一步相关性分析结果显示,TBI患者治疗前血清中D-乳酸、细菌内毒素及二胺氧化酶的水平与术前GCS评分呈负相关(r分别为-0.543、-0.617、-0.672,均P<0.01)。结论监测TBI患者血清中二胺氧化酶、D-乳酸及细菌内毒素的水平可作为评估其颅脑损伤后肠道黏膜屏障功能的重要指标。

Objective To investigate the roles of plasma D-lactate,endotoxin and diamineoxidase(DAO)in assessment of intestinal mucosal barrier function post traumatic brain injury(TBI).Methods We retrospectively studied 70 patients with TBI(TBI group)admitted to Department of Neurosurgery,the 904th Hospital of the Joint Service of Chinese People′s Liberation Army from January 2017 to August 2018,and 45 healthy subjects were enrolled as well(healthy control group)at the physical examination center during the same period.All TBI patients were treated conservatively or surgically.Peripheral blood of patients and healthy subjects were collected to detect levels of plasma D-lactic acid,endotoxin,and DAO.Further use of Spearman correlation analysis was conducted to determine the correlation between preoperative serum D-lactic acid,endotoxin and DAO and Glasgow Coma Scale(GCS)in patients with TBI.Results Compared with the healthy control group,the levels of D-lactic acid(24.7±9.4 mg/L vs.9.8±4.0 mg/L),endotoxin(9.1±5.8 U/L vs.4.0±2.2 U/L)and DAO(36.3±22.6 U/L vs.15.2±3.6 U/L)were significantly increased(t=9.82,2.84 and 3.49,respectively,all P<0.05).Further correlation analysis showed that serum D-lactic acid,endotoxin and DAO levels were negatively correlated with preoperative GCS scores(r=-0.543,-0.617 and-0.672,respectively,all P<0.01).Conclusion The preliminary results have suggested that the levels of D-lactic acid,bacterial endotoxin and DAO in the serum could be used as important indexes in evaluation of the intestinal mucosal barrier function in patients post TBI.