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

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(P0.001),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,P0.001,细菌内毒素水平与APACHE II评分:r=0.451,P0.001。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。

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

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 Evaluation Ⅱ （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.