中国现代普通外科进展
中國現代普通外科進展
중국현대보통외과진전
CHINESE JOURNAL OF CURRENT ADVANCES IN GENERAL SURGERY
2011年
2期
133-136
,共4页
肠黏膜屏障损伤%细菌移位%二胺氧化酶%PCR%全身炎症反应综合征
腸黏膜屏障損傷%細菌移位%二胺氧化酶%PCR%全身炎癥反應綜閤徵
장점막병장손상%세균이위%이알양화매%PCR%전신염증반응종합정
Gut barrier dysfunction%Bacterial translocation%Diamine oxidase%PCR%SIRS
目的:探讨消化道重建术后肠黏膜屏障损伤与肠道细菌移位(BT)及BT与术后全身炎症反应综合征(SIRS)的关系.方法:选择60例择期行消化道重建术的患者,于术前和术后1、3、5d采集外周血,进行血桨二胺氧化酶及全血细菌DNA检测.全血DNA提取后进行PCR扩增,采用的靶基因为大肠杆菌特异性β半乳糖苷酶基因和16SrRNA基因.观察患者至术后10d以监测SIRS情况.结果:术前PCR检测全血细菌DNA均为阴性,术后共有14例阳性.23例患者术后发生SIRS,其中12例患者PCR阳性.PCR阳性组SIRS发生率为85.7%(12/14),阴性组为23.9%(11/46)(P<0.01).术后出现SIRS的患者PCR阳性率为52.2%(12/23),无SIRS组为5.4%(2/37)(P<0.01).PCR阳性的患者血浆二胺氧化酶浓度较PCR阴性者明显升高(P<0.01),有SIRS的患者血浆二胺氧化酶较无SIRS患者明显升高(P<0.01).结论:消化道重建术后BT与肠黏膜屏障损伤密切相关,术后SIRS与BT密切相关.PCR技术可早期诊断细菌移位,对术后SIRS有较好的早期预警价值.
目的:探討消化道重建術後腸黏膜屏障損傷與腸道細菌移位(BT)及BT與術後全身炎癥反應綜閤徵(SIRS)的關繫.方法:選擇60例擇期行消化道重建術的患者,于術前和術後1、3、5d採集外週血,進行血槳二胺氧化酶及全血細菌DNA檢測.全血DNA提取後進行PCR擴增,採用的靶基因為大腸桿菌特異性β半乳糖苷酶基因和16SrRNA基因.觀察患者至術後10d以鑑測SIRS情況.結果:術前PCR檢測全血細菌DNA均為陰性,術後共有14例暘性.23例患者術後髮生SIRS,其中12例患者PCR暘性.PCR暘性組SIRS髮生率為85.7%(12/14),陰性組為23.9%(11/46)(P<0.01).術後齣現SIRS的患者PCR暘性率為52.2%(12/23),無SIRS組為5.4%(2/37)(P<0.01).PCR暘性的患者血漿二胺氧化酶濃度較PCR陰性者明顯升高(P<0.01),有SIRS的患者血漿二胺氧化酶較無SIRS患者明顯升高(P<0.01).結論:消化道重建術後BT與腸黏膜屏障損傷密切相關,術後SIRS與BT密切相關.PCR技術可早期診斷細菌移位,對術後SIRS有較好的早期預警價值.
목적:탐토소화도중건술후장점막병장손상여장도세균이위(BT)급BT여술후전신염증반응종합정(SIRS)적관계.방법:선택60례택기행소화도중건술적환자,우술전화술후1、3、5d채집외주혈,진행혈장이알양화매급전혈세균DNA검측.전혈DNA제취후진행PCR확증,채용적파기인위대장간균특이성β반유당감매기인화16SrRNA기인.관찰환자지술후10d이감측SIRS정황.결과:술전PCR검측전혈세균DNA균위음성,술후공유14례양성.23례환자술후발생SIRS,기중12례환자PCR양성.PCR양성조SIRS발생솔위85.7%(12/14),음성조위23.9%(11/46)(P<0.01).술후출현SIRS적환자PCR양성솔위52.2%(12/23),무SIRS조위5.4%(2/37)(P<0.01).PCR양성적환자혈장이알양화매농도교PCR음성자명현승고(P<0.01),유SIRS적환자혈장이알양화매교무SIRS환자명현승고(P<0.01).결론:소화도중건술후BT여장점막병장손상밀절상관,술후SIRS여BT밀절상관.PCR기술가조기진단세균이위,대술후SIRS유교호적조기예경개치.
Objective:To investigate gut barrier dysfunction and bacterial translocation (BT) in patients who underwent digestive tract reconstruction and to study the relationship between BT and acute systemic inflammatory state (SIRS). Method： Sixty patients who underwent selective digestive tract reconstruction were observed. Blood were collected before surgery and 1, 3, 5 days after surgery to detect plasma diamine oxidase(DAO) and bacterial DNA. PCR analysis was performed with β-Galactosidase gene of Eschenchia coli and 16SrRNA gene as target gene. The SIRS of all the patients were observed for 10 days. Result：All the PCR results before operation were negative, while there was positive in 14 patients after digestive tract reconstruction. There were 23 patients with SIRS after surgery, and 12 patients PCR result were positive among 23 patients with SIRS. 85.7% of the patients(12/14) with positive PCR result had SIRS, while 23.9% patients (11/46) with negative PCR result had SIRS (P<0.01).The positive PCR rate in SIRS was 52.2% (12/23), which was remarkably higher than that without SIRS(5.4%, 2/37, P<0.01).The levels of plasma DAO in patients with positive PCR result was significantly higher than those of the patients with negative PCR result (P<0.01). The levels of plasma DAO in patients with SIRS was significantly higher than those of patients without SIRS (P<0.01). Conclusion:The gut barrier dysfunction was closely related to BT, and BT was closely related to postoperative SIRS. PCR analysis can be used in early diagnosis of BT, the positive PCR result might be a useful early warning sign of postoperative SIRS.
