Functional changes of intestinal mucosal barrier in surgically critical patients

Abstract

Abstract:

BACKGROUND: The gut is capable of inducing multiple organ dysfunction syndrome (MODS). In the diagnosis and treatment of critical ill patients, doctors should pay particular attention to the protection or recovery of intestinal barrier function. However, no reliable diagnostic criteria are available clinically. This study aimed to assess the changes of intestinal mucosal barrier function in surgically critical ill patients as well as their significance.

METHODS: Thirty-eight surgically critical ill patients were enrolled as a study group (APACHE II>8 scores), and 15 non-critical ill patients without intestinal dysfunction were selected as a control group (APACHE II<6). General information, symptoms, physical signs, and APACHE II scores of the patients were recorded. The patients in the study group were subdivided into an intestinal dysfunction group (n=26) and a non-intestinal dysfunction group (n=12). Three ml venous blood was collected from the control group on admission and the same volume of plasma was collected from the study group both on admission and in the period of recovery. The plasma concentrations of endotoxin, diamine oxidase (DAO), D-lactate, and intestinal fatty-acid binding protein (iFABP) were detected respectively. The data collected were analyzed by the SPSS 17.0 software for Windows.

RESULTS: The levels of variables were significantly higher in the study group than in the control group (P<0.01). They were higher in the intestinal dysfunction group than in the non-intestinal dysfunction group (DAO P<0.05, endotoxin, D-lactate, iFABP P<0.01). In the non-intestinal dysfunction group compared with the control group, the level of endotoxin was not significant (P>0.05), but the levels of DAO, D-lactate and iFABP were statistically significant (P<0.05). The levels of variables in acute stage were higher than those in recovery stage (P<0.01).The death group showed higher levels of variables than the survival group (endotoxin and D-lactate P<0.01, DAO and iFABP P<0.05).

CONCLUSION: The plasma concentrations of endotoxin, DAO, D-lactate, and intestinal fatty-acid binding protein (iFABP) could reflect a better function of the intestinal mucosa barrier in surgically critical ill patients.

Key words: Intestinal mucosal barrier, Endotoxin, Diamine oxidase, D-lactate, Intestinal fatty-acid binding protein

Yuan-yuan Guo, Mu-lin Liu, Xian-di He, Cong-qiao Jiang, Rui-lin Liu. Functional changes of intestinal mucosal barrier in surgically critical patients[J]. World Journal of Emergency Medicine, 2010, 1(3): 205-208.

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References 15

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Group	Number of cases	Endotoxin (pg/ml)	D-lactate (mg/l)	DAO (kU/L)	iFABP (μmol/ml)
Intestinal dysfunction	26	9.94±8.92^*#	22.90±8.44^*#	18.40±11.46^*Δ	144.65±59.84^*#
Nonintestinal dysfunction	12	2.10±0.42	13.88±9.26^☆	9.70±5.33^☆	84.77±69.12^☆
Control	15	1.00±0.00	6.04±3.79	3.72±2.02	48.88±27.25
F		7.895	10.101	4.738	8.581
P			<0.01	<0.05	<0.05

Time	Number of cases	Endotoxin (pg/ml)	D-lactate (mg/l)	DAO (mg/ml)	iFABP (μmol/ml)
At admission	25	7.52±4.42	25.22±5.39	16.54±10.30	154.10±56.60
Recovery period	25	3.93±2.98	12.66±6.23	12.52± 5.07	77.60±59.63
t		3.025	5.061	4.429	6.163
P		<0.01	<0.01	<0.01	<0.01

Group	Number of cases	Endotoxin (pg/ml)	D-lactate (mg/l)	DAO (mg/ml)	iFABP (μmol/ml)
Death group	13	10.37±3.80	25.55±5.76	22.93± 8.40	193.37±72.41
Survival group	25	4.50±2.58	18.55±6.38	15.63± 5.29	140.36±43.68
t		10.854	10.214	4.651	6.921
P		<0.01	<0.01	<0.05	<0.05