Functional changes of intestinal mucosal barrier in

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

RESULTS： The levels of variables were significantly higher in the study group than in the control group （P

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

World J Emerg Med 2010；1（3）：205-208

INTRODUCTION

Studies have focused on the function of intestinal barrier.The gut is thought to induce multiple organ dysfunction syndrome （MODS）.[1] In the diagnosis and treatment of critical patients， the protection or recovery of the intestinal barrier function is extremely important. However， no reliable diagnostic criteria are available clinically. This study was undertaken to observe the changes of endotoxin， diamine oxidase （DAO）， D-lactate and intestinal fatty-acid binding protein （iFABP） in the plasma of critical patients， which accordingly could determine gastrointestinal dysfunction of patients.

METHODS

Patients

This study was a randomized， controlled trial. From February 2009 to August 2009， 38 surgically critical patients （APACHE II scores > 8） without gastrorrhexis， enterorrhexis or gastrointestinal operation were recruited at the First Affiliated Hospital of Bengbu Medical Collage， Bengbu. They were admitted to the hospital within 24 hours after onset of the disease. Among them， 24 were male and 14 female； their median age was 51 years （range 19-86 years）. Eleven patients had severe multiple injuries， 5 had alimentary tract hemorrhage， 6 had severe acute pancreatitis， 10 had gastrointestinal operation （operation for cerebral hemorrhage in 5 patients， hysterectomy in 3 patients， bone fracture reestablishment in 1 patient and amputation in 1 patient）， and 6 had shock. In this series， 25 patients had the condition improved and 13 patients died. The patients were divided into two groups： an intestinal dysfunction group （26 patients） and a nonintestinal dysfunction group （12 patients） according to the criteria set by the National Symposium on Intestinal Barrier Function in China[2] in 2006. At the same time， 15 non-critical patients undergoing selective operation， 9 males and 6 females， aged on average 45 years （range 23-65 years）， were enrolled in the control group. Age and sex distribution were not significantly different among the groups （P>0.05）.

Collection and conservation of specimens

Three ml blood was collected from the control group on admission （acute stage）， and the same volume of plasma was collected from the study group both on admission and in the period of revovery. The period of revovery was defined as the time when symptoms， physical signs and laboratory results were improved in addition to APACHE II score

Detection of laboratory parameters

The concentration of diamine oxidase （DAO） in the plasma was detected by absorption dpectrometry introduced by Jun-you Li.[3] D-lactate test was performed with O-dianisidine according to the Murray method.[4] The intestinal fatty-acid binding protein （iFABP） test used enzyme linked immunosorbent assay （ELISA） in accordance with ELISA package's description. Endotoxin test was performed with dynamic durbidity assay. DAO standard， D-lactate standard， lactic dehydrogenase （LDH） and O-dianisidine were bought from Sigma， but ELISA package was purchased from R & D.

Statistical analysis

The data were expressed as mean±SD. Univariate analysis was made between groups where necessary， the chi-square test and Fisher's exact test were used. Statistical significance was defined as P

RESULTS

Analysis of parameters

The levels of endotoxin， D-lactate， DAO， and iFABP were higher in the intestinal dysfunction group than those in the nonintestinal dysfunction group （P

Parameters on admission or in the period of recovery

The levels of endotoxin， D-lactate， DAO， and iFABP were higher on admission than in the period of revovery （P

Parameters of the death group and survival group

The levels of endotoxin， D-lactate， DAO， and iFABP were higher in the death group and the survival group （P

DISCUSSION

The gut is easily damaged when the human body is in ischemic or anoxic conditions. The damage including trauma， hemorrhage， stress， operative injury， infection， shock， etc could make intestinal mucosa ischemia and hypoxia.With an increased intestinal permeability， bacterial translocation and even MODS may occur. With ischemia of the intestinal mucosa， dysbacteria are induced， and gram-negative bacteria in the gut grow. Then endotoxin is released increasingly， resulting in damage to the body and MODS.[5-7] In this study， the levels of plasma endotoxin， D-lactate， DAO， iFABP were significantly higher in patients with intestinal dysfunction than in those without intestinal dysfunction and the controls. But the endotoxin level was not significantly higher in the patients without intestinal malfunction than in the controls. The accurate rate of the MB-80 microorganism detecting system was 1 pg/ml， and in the control group it was

In this study the levels of plasma endotoxin， D-lactate， DAO， and iFABP were significantly lower in the recovery stage than in the acute stage （P

In conclusion， monitoring of plasma endotoxin， DAO， D-lactate， and iFABP is helpful to evaluate the damage of the intestinal mucosa barrier， and possibly to make a judgement for patients' prognosis. Therefore， it is important for clinical doctors to early cure the surgically critical ill patients with intestinal dysfunction.

Funding： None.

Ethical approval： Not needed.

Conflicts of interest： No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Contributors： Guo YY wrote the main body of the article. All authors contributed to the design and interpretation of the study and to further drafts.

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Received March 6， 2010

Accepted after revision June 3， 2010