肝炎肝硬化患者血浆D-乳酸、二胺氧化酶和内毒素的检测及其临床意义

目的　探讨血D 乳酸、二胺氧化酶 (DAO)和内毒素水平在肝炎肝硬化患者中的变化及其临床意义。方法　将 5 0例肝炎肝硬化患者和 3 0例健康体检者分为试验组和对照组 ,采用分光光度法检测外周血中D 乳酸、DAO和内毒素的活性。结果　肝炎肝硬化患者试验组D 乳酸活性明显高于对照组 (P <0 .0 1) ,试验组 3组间比较差异有显著性 (P <0 .0 1) ,治疗后显著低于治疗前 (P <0 .0 1) ;试验组DAO活性明显高于对照组 ,组间比较Child PughC级组活性明显低于Child PughB级组 (P <0 .0 1) ,治疗后A级组及B级组水平显著低于治疗前 (P <0 .0 5 ) ,C级组水平显著高于治疗前 (P <0 .0 5 ) ;Child PughA级组内毒素活性与对照组比较差异显著性 (P >0 .0 5 ) ,Child PughB、C级组明显高于对照组 (P <0 .0 1) ,治疗后A、B级组水平与治疗前比较差异无显著性 (P >0 .0 5 ) ,C级组水平显著降低 (P <0 .0 1)。相关分析显示 3者水平均相关。结论　血浆D 乳酸、DAO水平是肠粘膜损伤早期诊断的敏感指标 ,内毒素血症是肝硬化患者病情加重的重要因素

Determination of plasma D(-)-lactate,diamine oxidase and endotoxin and its significance in the patients with liver cirrhosis

Objective To evaluate the significance of plasma D (-)-lactate,diamine oxidase (DAO) and endotoxin activities in the patients with liver cirrhosis.Methods Fifty patients with cirrhosis were employed as experimental group while 30 healthy people as control group.The plasma concentrations of D (-)-lactate,DAO and endotoxin were detected by spectrophotography.Results The concentration of D (-)-lactate in experimental group was significantly higher than that in the control group(P<0.01),there were significant differences of D(-)-lactate levels among different Child-Pugh class(P<0.01).After therapy,D(-)-lactate level in experimental group decreased significantly(P<0.01).The concentration of DAO in experimental group was significantly higher than that in the control group(P<0.01),but in Child-Pugh C group it was significantly lower than that in Child-Pugh B group(P<0.01).After therapy,DAO levels in Child-Pugh B and A groups decreased significantly(P<0.05),but increased in Child-Pugh C group(P<0.05).The level of endotoxin in experimental group had obviously increased except Child-Pugh class A(P<0.01).After therapy,endotoxin level decreased significantly in Child-Pugh C group(P<0.01).The plasma levels of D(-)-lactate,DAO and endotoxin were positively correlated with each other(P<0.01).Conclusion Both plasma D(-)-lactate and DAO activities were sensitive markers for early diagnosis of gut failure and endotoxemia in cirrhosis patients.The impairment of intestinal barrier function may be one of the critical reasons for cirrhosis deterioration.