服用阿司匹林患者血浆D-乳酸浓度与小肠黏膜损伤程度的关系

The relationship between plasma D-lactate level and small intestinal damage in patients taking aspirin

目的探讨服用阿司匹林患者血浆D-乳酸浓度与小肠黏膜损伤程度的关系。方法纳入2019年5月至2019年12月在首都医科大学附属北京安贞医院就诊的服用肠溶阿司匹林治疗1个月以上的患者106例,行磁控胶囊内镜检查评价小肠黏膜损伤情况,根据小肠病变内镜5级评分系统,将小肠黏膜正常者分入无损伤组、小肠黏膜红斑或1~4处小糜烂者分入轻度损伤组、大于4处小糜烂或发现大糜烂/溃疡者分入重度损伤组。分别采用比色法和酶联免疫吸附法检测血浆D-乳酸及炎症因子白细胞介素-1β、肿瘤坏死因子-α、白细胞介素-10的表达,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价D-乳酸浓度预测重度小肠损伤的有效性。结果106例服用阿司匹林患者中,无小肠损伤组14例、轻度小肠损伤组74例、重度小肠损伤组18例,3组患者血浆中D-乳酸浓度分别为106.59(70.17,278.11)、167.19(31.81,439.57)和349.88(182.23,1442.5)nmol/mL,3组间比较差异有统计学意义(P=0.022)。ROC曲线下面积是0.704(95%CI:0.572~0.836,P=0.006)。以约登指数最大点对应的D-乳酸浓度(754.15 nmol/mL)为临界值,当D-乳酸浓度≥754.15 nmol/mL时预测服用阿司匹林患者发生严重小肠黏膜损伤的灵敏度为44.4%,特异度为90.9%,Kappa=0.370,预测效果不理想。结论服用阿司匹林患者小肠黏膜损伤程度不同,血浆中D-乳酸表达浓度也不同,但血浆D-乳酸浓度预测阿司匹林相关严重小肠损伤的效果尚不理想。

Objective To investigate the relationship between plasma D-lactate level and small intestinal damage in patients taking aspirin.Methods From May 2019 to December 2019,106 patients who had been taking aspirin for over one month in Beijing Anzhen Hospital,Capital Medical University were enrolled.They were examined by magnetically controlled capsule endoscopy.According to the five-point scoring system for endoscopic lesions with capsule endoscopy,patients with normal small intestinal mucosa were divided into the normal group,those with erythema or 1-4 small erosions were divided into the mild damage group,and those with more than 4 small erosions or large erosions/ulcers were divided into the major damage group.The expression levels of plasma D-lactate and inflammatory factors interleukin-1β(IL-1β),tumor necrosis factor(TNF-α),interleukin-10(IL-10)were detected by colorimetry and enzyme-linked immunosorbent assay,respectively.The efficacy of D-lactate in the diagnosis of severe small intestinal damage was evaluated by receiver operating characteristic(ROC)curve.Results Among the 106 patients taking aspirin,14 cases were in the normal group,74 cases were in the mild damage group and 18 cases were in the major damage group.The plasma D-lactate levels of the three groups were 106.59(70.17,278.11)nmol/mL,167.19(31.81,439.57)nmol/mL and 349.88(182.23,1442.5)nmol/mL,there was significant difference among the three groups(P=0.022).The area under ROC curve was 0.704(95%CI:0.572-0.836,P=0.006).The level of D-lactate(754.15 nmol/mL)corresponding to the maximum point of Youden index was taken as the cut-off point.When D-lactate level≥754.15 nmol/ml,the sensitivity,specificity and kappa were 44.4%,90.9%and Kappa=0.370,respectively,the predicted effect was poor.Conclusion The levels of plasma D-lactate varies with the degree of small intestinal damage in patients taking aspirin.However,the effect of plasma D-lactate level in predicting aspirin related severe small intestinal damage is not ideal.