儿童肝移植围手术期肠黏膜屏障功能改变与耐碳青霉烯类肠杆菌定植的相关性研究  

Correlation between changes of intestinal mucosal barrier function and carbapenem-resistant enterobacter colonization during perioperative period of pediatric liver transplantation

作　　者：孙雁[1] 王兵[1] 高思楠[1] 窦晓婧[1] 孙超[2] 程悦[3] Sun Yan;Wang Bing;Gao Sinan;Dou Xiaojing;Sun Chao;Cheng Yue(Department of Surgical Intensive Care Unit,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300380,China;Department of liver transplantation,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300380,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300380,China)

机构地区：[1]天津市第一中心医院外科重症监护室天津市器官移植重点实验室,天津300380 [2]天津市第一中心医院肝移植科天津市器官移植重点实验室,天津300380 [3]天津市第一中心医院放射科,天津300380

出　　处：《临床小儿外科杂志》2025年第3期215-219,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然基金项目(32371426);天津市自然科学基金(21JCYBJC01290);天津市卫生健康科技重点学科专项(TJWJ2023XK012);感染性疾病国家临床重点专科建设项目(8235)。

摘　　要：目的探讨儿童肝移植围手术期肠黏膜屏障功能受损与耐碳青霉烯类肠杆菌(carbapenem-resistant enterobacteria,CRE)定植的相关性,以及术后肠黏膜损伤修复的一般规律。方法本研究为回顾性研究,以2022年11月1日至2022年12月31日在天津市第一中心医院行肝移植术的40例胆道闭锁婴幼儿作为研究对象,根据肛拭子检测结果将患儿分为CRE定植组和无CRE定植组。分别于术前24 h、术后24 h、术后7 d抽取静脉血检测D-乳酸及二胺氧化酶。比较两组患儿术后D-乳酸及二胺氧化酶的差异及变化,初步分析肝移植术后肠黏膜损伤及修复的一般规律。结果无论在CRE定植组还是无CRE定植组,D-乳酸及二胺氧化酶水平在术后24 h均达到峰值,CRE定植组术后24 h与术前24 h的D-乳酸、术后24 h与术后7 d的D-乳酸,无CRE定植组术后24 h与术前24 h的D-乳酸、术后24 h与术后7 d的D-乳酸,CRE定植组与无CRE定植组术后24 h的D-乳酸比较,差异均有统计学意义(P<0.05)。CRE定植组术后24 h与术前24 h的二胺氧化酶、术后24 h与术后7 d的二胺氧化酶[(0.22±0.04)U/L比(0.18±0.06)U/L],无CRE定植组术后24 h与术前24 h的二胺氧化酶、术后24 h与术后7 d的二胺氧化酶,CRE定植组与无CRE定植组术后24 h的二胺氧化酶比较,差异均有统计学意义(P<0.05)。而两组术前24 h与术后7 d的D-乳酸及二胺氧化酶水平以及两组之间术前24 h、术后7 d的D-乳酸及二胺氧化酶水平差异均无统计学意义(P>0.05)。结论D-乳酸及二胺氧化酶作为肠黏膜损伤的敏感指标,在肝移植围手术期有相似的变化趋势,术后24 h内达到峰值;随着肠黏膜屏障功能的修复,在术后1周左右接近术前水平。有CRE定植的患儿肝移植术后肠黏膜屏障功能的损伤程度较无CRE定植的患儿更严重。Objective To explore the correlation between intestinal mucosal barrier function impairment and rectal colonization of carbapenem-resistant enterobacteria(CRE)during pediatric liver transplantation(LT)and summarize the general rules of postoperative intestinal mucosal impairment and repairing.Methods From November 1st,2022 to December 31st,2022,40 children with biliary atresia(BA)undergoing LT were assigned into two groups of CRE colonization and non-CRE colonization according to the results of anal swabs.At 24 h pre-operation,24 h post-operation and Day 7 post-operation,venous blood samples were collected for detecting the levels of D-lactic acid and diamine oxidase(DAO).The inter-group differences and changes of D-lactic acid and DAO were compared.And general rules of intestinal mucosal impairment and repairing post-LT was preliminarily examined.Results The levels of D-lactic acid and DAO peaked at 24 h post-operation in both groups.In CRE colonization group,D-lactic acid of 24 h post-operation and 24 h pre-operation,24 h post-operation and Day 7 post-operation.In non-CRE colonization group,D-lactic acid of 24 h post-operation and 24 h pre-operation,24 h post-operation and Day 7 post-operation;D-lactic acid of 24 h post-operation in CRE colonization and non-CRE colonization groups.The differences were statistically significant(P<0.05);In CRE colonization group,DAO of 24 h post-operation and 24 h pre-operation[(0.22±0.04)vs.(0.16±0.05)U/L],24 h post-operation and Day 7 post-operation.In non-CRE colonization group,DAO of 24 h post-operation and 24 h pre-operation[(0.17±0.01)vs.(0.13±0.02)U/L],24 h post-operation and Day 7 post-operation,DAO of 24 h post-operation in CRE colonization and non-CRE colonization groups.The differences were statistically significant(P<0.05).However,the levels of D-lactic acid and DAO at 24 h pre-operation and Day 7 post-operation had no significant differences in neither groups.The levels of D-lactic acid and DAO at 24 h pre-operation and Day 7 post-operation had no significant int

关 键 词：肝移植 耐碳青霉烯类肠杆菌 D-乳酸 二胺氧化酶 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]