CAJ | 학술논문

目的探讨结肠慢传输型便秘(STC)患者肠黏膜屏障功能的状态.方法选取2008年6月至2012年6月的STC患者136例,其中病程1～＜6年者55例,6～10年者43例,＞10年者38例;结肠传输时间3～＜5 d者66例,5～7 d者42例,＞7 d者28例;接受结肠次全切除术者35例.以同期30例因结肠单个息肉接受结肠部分切除术者为对照组.采集所有研究对象的空腹血、尿标本.取STC手术者和对照组的结肠标本.采用高效液相色谱法(HPLC)检测尿乳果糖与甘露醇比值(L/M).采用酶学分光光度法检测血D-乳酸水平.采用分光光度法检测血二胺氧化酶(DAO)水平.采用基质偶氮显色鲎试验法检测血内毒素水平.采用Ussing灌流室检测结肠上皮细胞细胞跨膜电阻(TER)和细胞旁路甘露醇通透性(PMP).组间比较行t检验.结果 STC组和对照组的尿L/M分别为0.16±0.03和0.10±0.02,血D-乳酸水平分别为(1.81±0.19)和(1.04±0.13) mmol/L,血DAO水平分别为(17.07±1.81)和(9.78±1.14) U/L,血内毒素水平分别为(64.20±6.85)和(51.30±5.90) EU/L,结肠上皮细胞TER分别为(61.23±7.76)和(75.87±9.65)Ω/cm2,结肠上皮细胞PMP分别为(3.17±0.35)％和(2.14±0.22)％,差异均有统计学意义(t=3.185、3.378、3.863、3.201、3.125、3.543,P均＜0.05).STC病程1～＜6年者、6～10年者、＞10年者,以及STC结肠传输时间3～＜5 d者、5～7 d者、＞7d者的尿L/M、血D-乳酸水平、血DAO水平皆随病程和结肠传输时间延长而上升,与对照组比较差异均有统计学意义(尿L/M的t=1.993、2.311、2.356、2.204、2.347、3.673,血D-乳酸的t=2.023、2.886、4.124、1.999、2.998、3.465,血DAO的t=1.994、2.995、4.423、2.203、3.673、5.211,P均＜0.05).STC病程6～10年者和＞10年者,以及STC结肠传输时间5～7 d者和＞7d者的血内毒素水平与对照组比较差异均有统计学意义(t=2.121、4.245、3.241、4.657,P均＜0.05).结论 STC患者肠黏膜屏障通透性增加,且结肠传输时间和病程长者通透性增加似更明显. 目的探討結腸慢傳輸型便祕(STC)患者腸黏膜屏障功能的狀態.方法選取2008年6月至2012年6月的STC患者136例,其中病程1～＜6年者55例,6～10年者43例,＞10年者38例;結腸傳輸時間3～＜5 d者66例,5～7 d者42例,＞7 d者28例;接受結腸次全切除術者35例.以同期30例因結腸單箇息肉接受結腸部分切除術者為對照組.採集所有研究對象的空腹血、尿標本.取STC手術者和對照組的結腸標本.採用高效液相色譜法(HPLC)檢測尿乳果糖與甘露醇比值(L/M).採用酶學分光光度法檢測血D-乳痠水平.採用分光光度法檢測血二胺氧化酶(DAO)水平.採用基質偶氮顯色鱟試驗法檢測血內毒素水平.採用Ussing灌流室檢測結腸上皮細胞細胞跨膜電阻(TER)和細胞徬路甘露醇通透性(PMP).組間比較行t檢驗.結果 STC組和對照組的尿L/M分彆為0.16±0.03和0.10±0.02,血D-乳痠水平分彆為(1.81±0.19)和(1.04±0.13) mmol/L,血DAO水平分彆為(17.07±1.81)和(9.78±1.14) U/L,血內毒素水平分彆為(64.20±6.85)和(51.30±5.90) EU/L,結腸上皮細胞TER分彆為(61.23±7.76)和(75.87±9.65)Ω/cm2,結腸上皮細胞PMP分彆為(3.17±0.35)％和(2.14±0.22)％,差異均有統計學意義(t=3.185、3.378、3.863、3.201、3.125、3.543,P均＜0.05).STC病程1～＜6年者、6～10年者、＞10年者,以及STC結腸傳輸時間3～＜5 d者、5～7 d者、＞7d者的尿L/M、血D-乳痠水平、血DAO水平皆隨病程和結腸傳輸時間延長而上升,與對照組比較差異均有統計學意義(尿L/M的t=1.993、2.311、2.356、2.204、2.347、3.673,血D-乳痠的t=2.023、2.886、4.124、1.999、2.998、3.465,血DAO的t=1.994、2.995、4.423、2.203、3.673、5.211,P均＜0.05).STC病程6～10年者和＞10年者,以及STC結腸傳輸時間5～7 d者和＞7d者的血內毒素水平與對照組比較差異均有統計學意義(t=2.121、4.245、3.241、4.657,P均＜0.05).結論 STC患者腸黏膜屏障通透性增加,且結腸傳輸時間和病程長者通透性增加似更明顯.
목적 탐토결장만전수형편비(STC)환자장점막병장공능적상태.방법 선취2008년6월지2012년6월적STC환자136례,기중병정1～＜6년자55례,6～10년자43례,＞10년자38례;결장전수시간3～＜5 d자66례,5～7 d자42례,＞7 d자28례;접수결장차전절제술자35례.이동기30례인결장단개식육접수결장부분절제술자위대조조.채집소유연구대상적공복혈、뇨표본.취STC수술자화대조조적결장표본.채용고효액상색보법(HPLC)검측뇨유과당여감로순비치(L/M).채용매학분광광도법검측혈D-유산수평.채용분광광도법검측혈이알양화매(DAO)수평.채용기질우담현색후시험법검측혈내독소수평.채용Ussing관류실검측결장상피세포세포과막전조(TER)화세포방로감로순통투성(PMP).조간비교행t검험.결과 STC조화대조조적뇨L/M분별위0.16±0.03화0.10±0.02,혈D-유산수평분별위(1.81±0.19)화(1.04±0.13) mmol/L,혈DAO수평분별위(17.07±1.81)화(9.78±1.14) U/L,혈내독소수평분별위(64.20±6.85)화(51.30±5.90) EU/L,결장상피세포TER분별위(61.23±7.76)화(75.87±9.65)Ω/cm2,결장상피세포PMP분별위(3.17±0.35)％화(2.14±0.22)％,차이균유통계학의의(t=3.185、3.378、3.863、3.201、3.125、3.543,P균＜0.05).STC병정1～＜6년자、6～10년자、＞10년자,이급STC결장전수시간3～＜5 d자、5～7 d자、＞7d자적뇨L/M、혈D-유산수평、혈DAO수평개수병정화결장전수시간연장이상승,여대조조비교차이균유통계학의의(뇨L/M적t=1.993、2.311、2.356、2.204、2.347、3.673,혈D-유산적t=2.023、2.886、4.124、1.999、2.998、3.465,혈DAO적t=1.994、2.995、4.423、2.203、3.673、5.211,P균＜0.05).STC병정6～10년자화＞10년자,이급STC결장전수시간5～7 d자화＞7d자적혈내독소수평여대조조비교차이균유통계학의의(t=2.121、4.245、3.241、4.657,P균＜0.05).결론 STC환자장점막병장통투성증가,차결장전수시간화병정장자통투성증가사경명현.
Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.