选择性肠道去污染对创伤性截瘫家兔血浆二胺氧化酶和D乳酸的影响

目的探讨选择性肠道去污染对急性创伤性截瘫家兔血浆二氨氧化酶(DAO)、D乳酸(D-LA)水平的影响。方法建立截瘫家兔模型,采用PTA方案进行消化道选择性去污染(SDD)处理4d。采集小肠标本进行HE染色观察小肠黏膜变化,采集血液标本检测血浆DAO、D乳酸水平,并分析DAO、D乳酸水平与肠黏膜损伤程度的关系以及对肠黏膜屏障功能的诊断价值。结果 SDD处理组血浆DAO水平较对照组明显降低(5.92±1.19)U/L vs.(12.46±1.93)U/L,P<0.001],截瘫家兔经SDD处理后D-LA水平也较对照组明显降低(10.7±2.8)mg/L vs.(35.5±4.6)mg/L,P<0.001]。Speraman相关分析表明,DAO(r=0.583)、D-LA(r=0.490)与肠道黏膜上皮损伤程度呈正相关(P<0.001)。ROC曲线分析显示DAO最佳诊断界点为6.54 U/L,D-LA是12.74 mg/L;DAO和D-LA曲线下面积分别为0.73695%CI(0.569~0.903)]、0.70395%CI(0.545~0.862)]。结论 DAO和D-LA在经SDD处理的创伤性截瘫家兔水平明显降低,且可作为截瘫后肠黏膜屏障功能损害的早期诊断指标。

Effect of Selective Decontamination of the Digestive Tractondiamine Oxidase and D-Lactatein Rabbits with Complete Paraplegia

Objective To investigate morphological changes of small intestinal mucosa in paraplegic rabbits treated with selective digestive decontamination( SDD).Methods Animals were subjected to a complete paraplegia following spinal cord injury,and divided into SDD-treated and control groups.The treatment group received SDD by gavage three times daily for 4 daysafter injury.The control group was given the same amount of normal saline. Samples fromthe blood and small intestine were collected to detect DAO,D-lactic acid levels and to assess morphological changes in the small intestine,using Hematoxylin and eosin staining.The correlation between DAO,D-LA level andthe degree of intestinal mucosal damagewere analysed.Receiver operating characteristic( ROC) curvewas plotted to estimate the diagnostic value of DAO and D-LA level to intestinal mucosal injury. Results The plasma levels of DAO and D-LA was significantly lower in the SDD group than that in the control group( P<0. 001).The levels of D-LA and DAO were positively correlated with the degree of intestinal mucosal damage( P< 0. 001). The cutoff point of DAO and D-LA was 6. 54 U/L and 12. 74 mg/L,and the area under the ROC curve for DAO and D-LA was 0. 73695%CI( 0. 569 ~ 0. 903)and 0. 70395%CI( 0. 545 ~ 0. 862) ],respectively. Conclusion The plasma levels of DAO and D-LA was significantly lower in paraplegic rabbits treated with SDD.Both plasma DAO and D-LA concentration are sensitive markers for early diagnosis of intestinal mucosal damage in rabbits with complete paraplegia.