血清D-乳酸、二胺氧化酶和细菌内毒素对原发性肝癌放疗患者的意义  

Clinical study on serum D-lactate,diamine oxidase,and bacterial endotoxin in radiotherapy-treated patients with primary liver cancer

作　　者：张玲玲[1] 郭英[1] 徐慧[1] 杜红珍[2] 李娜[1] 薄常文 ZHANG Lingling;GUO Ying;XU Hui(Department of Oncology,the First Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院肿瘤科,石家庄市050000 [2]河北医科大学第一医院临床营养科,石家庄市050000

出　　处：《河北医药》2023年第16期2431-2434,2439,共5页Hebei Medical Journal

基　　金：民生科技专项(编号:19277733D)。

摘　　要：目的探讨血清中D-乳酸、二胺氧化酶和细菌内毒素水平在原发性肝癌放疗患者中的变化及其在肠道屏障功能评估中的临床意义。方法序贯纳入2020年1月至2021年12月150例原发性肝癌且均需行局部放射治疗的患者。住院24 h内进行患者主观整体营养评估(PG-SGA)、mGPS评分,并根据是否合并胃肠功能障碍分为胃肠功能障碍组和非胃肠功能障碍组,分别取患者放疗开始前、放疗完成时以及放疗完成后1个月3个时间段的外周血,以检测血清中D-乳酸、DAO和细菌内毒素的水平。比较3组血清中D-乳酸、DAO和细菌内毒素水平变化,进一步判断肝癌患者放疗前血清中D-乳酸、DAO和内毒素与PG-SGA、mGPS、胃肠功能障碍之间的关系。结果放疗开始前、放疗完成时及放疗完成1个月3组患者的血清中D-乳酸分别为[5.30(0.34~10.52)]mg/L、[16.25(14.73~20.01)]mg/L、[16.85(3.23~34.20)]mg/L,二胺氧化酶分别为[5.92(0.12~9.06)]U/L、[12.89(7.43~22.05)]U/L、[14.47(13.30~19.41)]U/L,细菌内毒素分别为[5.68(1.78~9.83)]U/L、[9.72(6.36~15.71)]U/L、18.45[(15.99~23.25)]U/L,3组间D-乳酸、DAO和细菌内毒素水平明显呈上升趋势,差异有统计学意义,且两两比较发现D-乳酸及DAO水平在放疗开始前与放疗完成时、放疗完成1个月后之间均有统计学差异(P<0.05),而放疗完成时与放疗完成1个月后无统计学差异(P>0.05);放疗前胃肠功能障碍组的患者血清D-乳酸、二胺氧化酶及细菌内毒素水平分为(22.92±16.62)mg/L、(13.95±9.18)U/L、(32.08±21.85)U/L,均高于非胃肠功能障碍组即分别为(17.63±13.75)mg/L、(9.43±8.05)U/L、(10.95±10.14)U/L,且放疗前D-乳酸、二胺氧化酶、细菌内毒素水平与PG-SGA、mGPS评分均呈显著正相关,差异均有统计学意义(P<0.05)。结论监测原发性肝癌放疗患者血清中D-乳酸、DAO及细菌内毒素水平可作为评估患者胃肠功能障碍、营养状况及炎症状况的指标。Objective To explore the changes in serum levels of D-lactate,diamine oxidase(DAO),and bacterial endotoxin in radiotherapy-treated patients with primary liver cancer and their clinical significance in evaluating intestinal barrier function.Methods A total of 150 local radiotherapy-treated patients with primary liver cancer visited in our hospital from January 2020 to December 2021 were sequentially included,and local radiotherapy was required according to their condition.All included patients were scored with the Scored Patient-Generated Subjective Global Assessment(PG-SGA)and the modified Glasgow Prognostic Score(mGPS)within 24 hours of admission.They were divided into gastrointestinal dysfunction group and non-gastrointestinal dysfunction group based on the presence or absence of gastrointestinal dysfunction.Peripheral blood samples were collected from patients before,after,and one month after radiotherapy to detect serum levels of D-lactate,diamine oxidase(DAO),and bacterial endotoxin,and compared their changes at the three time points.The correlation of serum levels of D-lactate,DAO,and bacterial endotoxin before radiotherapy,PG-SGA score,mGPS score,and gastrointestinal dysfunction in patients with primary liver cancer was identified.Results Serum level of D-lactate in patients with primary liver cancer before,after,and one month after radiotherapy was 5.30(0.34-10.52)mg/L,16.25(14.73-20.01)mg/L and 16.85(3.23-34.20)mg/L,respectively.Serum DAO level at the three time points was 5.92(0.12-9.06)U/L,12.89(7.43-22.05)U/L and 14.47(13.30-19.41)U/L,respectively.Serum level of bacterial endotoxin at the three time points was 5.68(1.78-9.83)U/L,9.72(6.36-15.71)U/L and18.45(15.99-23.25)U/L,respectively.Serum levels of D-lactate,DAO,and bacterial endotoxin before,after,and one month after radiotherapy showed an obvious upward trend,with significant differences(P<0.05).Furthermore,the pairwise comparison showed that serum levels of D-lactate and DAO before radiotherapy were significantly lower than those at the end of r

关 键 词：原发性肝癌 D-乳酸 二胺氧化酶 细菌内毒素 肠道屏障 

分 类 号：R735.7[医药卫生—肿瘤]