肠脂肪酸结合蛋白和 D-乳酸在早期诊断嵌顿疝肠坏死中的应用研究

目的 探讨肠脂肪酸结合蛋白(I-FABP)和D-乳酸(D-LAC)早期诊断嵌顿疝肠坏死的价值。方法:选取36只SD大鼠，实验组(n=18)制作嵌顿疝动物模型，对照组(n=18)未制作。在术后30 min、2 h、4 h、6 h、8 h和12 h，采用ELISA检测两组血清D-LAC和I-FABP的水平；RT-qPCR鉴定嵌顿疝肠管组织中I-FABP的表达。通过嵌顿肠管大体标本、苏木素伊红(HE)染色和Chiu’s评分判定肠坏死情况。结果:与对照组相比，实验组在术后6 h时嵌顿肠管大体标本和HE染色呈典型肠绞窄表现，Chiu’s评分有统计学意义(P=0.001)，血D-LAC明显升高(P=0.002)；8 h时肠管逐渐向肠坏死过渡，血D-LAC进一步升高(P=0.012)，血I-FABP也明显升高(P=0.001)，并且肠组织中的I-FABP表达明显升高(P=0.002)。12 h时肠管呈现明显肠坏死特征、Chiu’s评分有统计学意义(P=0.001)，血D-LAC和I-FABP均升至最高[(2019.60±16.17)μg/L vs(273.18±14.63)μg/L，P=0.001；(1210.94±5.96)μg/L vs (220.46±9.63)μg/L，P=0.001]；肠管组织中的I-FABP表达最高[(8.20±0.60)μg/L vs (1.13±0.16)μg/L，P=0.001]。结论:嵌顿疝大鼠血清I-FABP和D-LAC水平升高，为早期诊断嵌顿疝肠管坏死的临床研究提供了依据。

The role of intestinal fatty acid binding protein and D-lactic acid in the early diagnosis of intestinal necrosis in incarcerated hernia

Objective　To investigate the role of intestinal fatty acid binding protein (I-FABP) and D-lactate(D-LAC) in the diagnosis of intestinal necrosis in incarcerated hernia.　Methods　Sprague Dawley rats were used for incarcerated hernia model, and then divided into control group (n=18) and experimental group (n=18). At 30 min, 2 h, 4 h, 6 h, 8 h and 12 h after operation, the levels of D-LAC and I-FABP in peripheral blood of the two groups were detected by ELISA. RT-qPCR was used to identify the expression of I-FABP in the intestinal tissue of incarcerated hernia. Intestinal necrosis was determined by gross specimen, HE staining and Chiu''s score.　Results　Compared with the control group, the experimental group showed typical intestinal strangulation at 6 h after operation, Chiu''s score was statistically significant (P=0.001), and the serum D-LAC level was significantly increased (P=0.002). At 8 h, the intestine gradually became necrotic, and the serum D-LAC level was further increased (P=0.012), the serum I-FABP level was also significantly increased (P=0.001), and the expression of I-FABP in intestinal tissue was significantly increased (P=0.002). At 12 h, the intestine showed obvious characteristics of intestinal necrosis, Chiu''s score was statistically significant (P=0.001), and the serum D-LAC and I-FABP increased to the highest level [(2019.60±16.17)μg/L vs (273.18±14.63)μg/L, P=0.001; (1210.94±5.96)μg/L vs (220.46±9.63)μg/L, P=0.001]. The expression of I-FABP in intestinal tissue was the highest [(8.20±0.60)μg/L vs (1.13±0.16)μg/L, P=0.001].　Conclusion　The increased serum levels of I-FABP and D-LAC provide clinical evidence for the early diagnosis of intestinal necrosis in incarcerated hernia.