肠脂肪酸结合蛋白和D-乳酸在早期诊断嵌顿疝肠坏死中的应用研究  

The role of intestinal fatty acid binding protein and D-lactic acid in the early diagnosis of intestinal necrosis in incarcerated hernia

作　　者：满艺[1] 石松荔[2] 李宝山 黄皇[1] 王荫龙[1] MAN Yi;SHI Song-li;LI Bao-shan(Department of Hernia Surgery,Tianjin Union Medicine Centre,Tianjin(300121),China)

机构地区：[1]天津市人民医院疝和腹壁外科,天津300121 [2]天津市人民医院病理科,天津300121

出　　处：《中国中西医结合外科杂志》2024年第2期274-278,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市人民医院院级课题(2017YJ016)。

摘　　要：目的:探讨肠脂肪酸结合蛋白(I-FABP)和D-乳酸(D-LAC)早期诊断嵌顿疝肠坏死的价值。方法:选取36只SD大鼠,实验组(n=18)制作嵌顿疝动物模型,对照组(n=18)未制作。在术后30 min、2 h、4 h、6 h、8 h和12 h,采用ELISA检测两组血清D-LAC和I-FABP的水平;RT-qPCR鉴定嵌顿疝肠管组织中I-FABP的表达。通过嵌顿肠管大体标本、苏木素伊红(HE)染色和Chiu’s评分判定肠坏死情况。结果:与对照组相比,实验组在术后6 h时嵌顿肠管大体标本和HE染色呈典型肠绞窄表现,Chiu’s评分有统计学意义(P=0.001),血D-LAC明显升高(P=0.002);8 h时肠管逐渐向肠坏死过渡,血D-LAC进一步升高(P=0.012),血I-FABP也明显升高(P=0.001),并且肠组织中的I-FABP表达明显升高(P=0.002)。12 h时肠管呈现明显肠坏死特征、Chiu’s评分有统计学意义(P=0.001),血D-LAC和I-FABP均升至最高[(2019.60±16.17)μg/L vs(273.18±14.63)μg/L,P=0.001;(1210.94±5.96)μg/L vs(220.46±9.63)μg/L,P=0.001];肠管组织中的I-FABP表达最高[(8.20±0.60)μg/L vs(1.13±0.16)μg/L,P=0.001]。结论:嵌顿疝大鼠血清I-FABP和D-LAC水平升高,为早期诊断嵌顿疝肠管坏死的临床研究提供了依据。Objective To investigate the role of intestinal fatty acid binding protein(I-FABP)and D-lactate(D-LAC)in the diagnosis of intestinal necrosis in incarcerated hernia.Methods Sprague Dawley rats were used for incarcerated hernia model,and then divided into control group(n=18)and experimental group(n=18).At 30 min,2 h,4 h,6 h,8 h and 12 h after operation,the levels of D-LAC and I-FABP in peripheral blood of the two groups were detected by ELISA.RT-qPCR was used to identify the expression of I-FABP in the intestinal tissue of incarcerated hernia.Intestinal necrosis was determined by gross specimen,HE staining and Chiu's score.Results Compared with the control group,the experimental group showed typical intestinal strangulation at 6 h after operation,Chiu's score was statistically significant(P=0.001),and the serum D-LAC level was significantly increased(P=0.002).At 8 h,the intestine gradually became necrotic,and the serum D-LAC level was further increased(P=0.012),the serum I-FABP level was also significantly increased(P=0.001),and the expression of I-FABP in intestinal tissue was significantly increased(P=0.002).At 12 h,the intestine showed obvious characteristics of intestinal necrosis,Chiu's score was statistically significant(P=0.001),and the serum D-LAC and I-FABP increased to the highest level[(2019.60±16.17)μg/L vs(273.18±14.63)μg/L,P=0.001;(1210.94±5.96)μg/L vs(220.46±9.63)μg/L,P=0.001].The expression of I-FABP in intestinal tissue was the highest[(8.20±0.60)μg/L vs(1.13±0.16)μg/L,P=0.001].Conclusion The increased serum levels of I-FABP and D-LAC provide clinical evidence for the early diagnosis of intestinal necrosis in incarcerated hernia.

关 键 词：嵌顿疝 肠坏死 肠脂肪酸结合蛋白 D-乳酸 

分 类 号：R656.2[医药卫生—外科学]