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当前位置：国际临床研究杂志 > 2021年 5卷 (4)期

Open Access Article

International Journal of Clinical Research. 2021; 5: (4) ; 1-8 ; DOI: 10.12208/j.ijcr.20210031.

Comparison of intestinal mucosal permeability between acute appendicitis and chronic cholecystitis before and during operation
急性阑尾炎和慢性胆囊炎术前和术中肠粘膜通透性的比较

作者： 陈雪峰, 丁倩男, 朱烨柯, 祝胜美, 李玉红 *

浙江大学医学院附属第一医院麻醉科浙江杭州

绍兴市人民医院医学研究中心浙江绍兴

树人大学树兰国际医学院树兰（杭州）医院麻醉科浙江杭州

*通讯作者：李玉红,单位：树人大学树兰国际医学院树兰（杭州）医院麻醉科浙江杭州；

浙江省科学技术厅基础公益项目浙江省卫计委医药卫生科技计划

发布时间: 2021-11-09 总浏览量: 1119

PDF 全文下载引用本文收录截图（CNKI-Scholar）

摘要

目的探索急性阑尾炎和慢性胆囊炎患者术前和术中肠粘膜的通透性。方法本研究前瞻性对照研究。选择2015年3月-2017年4月绍兴市人民医院44例美国麻醉医师协会（ASA）分级 I-II级，包括急性阑尾炎（阑尾组，n = 22）或者慢性胆囊炎患者（胆囊组，n = 22）。所有患者全身麻醉下实施腹腔镜手术，术中静脉泵注丙泊酚、舒芬太尼和肌松药维持麻醉深度，术毕静脉自控镇痛（PCIA）。分别于麻醉前和术毕采集动脉血采用酶联免疫法（ELISA）法测定血浆肿瘤坏死因子α （TNF-α）、白介素10（IL-10）、（Syndecan-1, SDC-1）、脂多糖（LPS）、脂肪酸结合蛋白2（FABP2）、D-乳酸（D-Lac）血浆浓度，采用免疫比浊法测定血浆C反应蛋白（CRP）浓度。结果阑尾组术前或术毕TNF-α、CRP均高于胆囊组（组间比较，P < 0.05）；两组患者术前后TNF-α和CRP浓度没有变化（组内比较，P > 0.05）。胆囊组术毕IL-10较术前降低（P = 0.015），而阑尾组术前后相当（P = 0.579）；术前胆囊组IL-10高于阑尾组（P = 0.036），而术毕阑尾组高于胆囊组（P = 0.020）。D-Lac组内或组间比较均无差别（P > 0.05）。两组患者LPS术前均高于术毕（P < 0.05）；但是两组间比较差别无显著意义（P > 0.05）。两组患者SDC-1术毕显著低于术前（P < 0.0001）；胆囊组术前（P = 0.020）或者术毕（P = 0.012）均高于阑尾组。两组患者术前后FABP2浓度变化无统计学意义（P > 0.05）；术前胆囊组高于阑尾组（P = 0.042），术毕两组差异无统计学意义（P = 0.611）。结论慢性胆囊炎患者术前术中肠粘膜通透性高于急性阑尾炎，并且不能以炎症因子的水平来解释。

关键词： 急性阑尾炎；慢性阑尾炎；肠粘膜通透性；炎性因子

Abstract

Objective To explore the effect of laparoscopic surgery on intestinal mucosal permeability in patients with acute appendicitis and chronic cholecystitis.
Methods This is a control prospective study. From March 2015 to April 2017, a total of forty-four patients of American Society of Anesthesiologists (ASA) grade I-II in Shaoxing People’s Hospital were included, including patients with acute appendicitis (Appendix group, n = 22) or chronic cholecystitis (Gallbladder group, n = 22). All patients underwent laparoscopic surgery under general anesthesia, and intravenous infusion of propofol, sufentanil and muscle relaxant were used to maintain the depth of anesthesia with patient controlled intravenous analgesia (PCIA) postoperatively. Before anesthesia and at the end of surgery, arterial blood was collected for the measurements of plasma concentration of tumor necrosis α (TNF-α), interleukin 10 (IL-10), Syndecan-1 (SDC-1), lipopolysaccharide (LPS), fatty acid blind protein 2 (FABP2), D-lactic (D-Lac) by using enzyme-linked immunoassay (ELISA); while immune turbidimetric method was used to determine the plasma C reactive protein (CRP).
Results Both TNF-α and CRP were higher in the Appendix group than in the Gallbladder group (inter group comparison, P <0.05). There was no change of TNF - α and CRP in the two groups before and after operation (intragroup comparison, P > 0.05). In the Gallbladder group, IL-10 decreased after surgery (P = 0.015), while in the Appendix group it was comparable (P = 0.579). Preoperative IL-10 was higher in Gallbladder group than in Appendix group (P = 0.036); while postoperative one was lower in Gallbladder group than Appendix group (P = 0.020). There was no difference intergroup or intragroup for D-Lac (P > 0.05). Both groups had higher LPS pre- than post operation (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). The postoperative SDC-1 of both groups was significantly lower than preoperative (P < 0.0001). Pre- (P = 0.020) or post-operative (P = 0.012) of SDC-1 in the Gallbladder group were higher than those in the Appendix group. There was no significant difference in the concentration of FABP2 between the two groups before and after operation (P > 0.05); the concentration of FABP2 in the gallbladder group before operation was higher than that in the appendix group (P = 0.042), and there was no significant difference between the two groups after operation (P = 0.611).
Conclusion The intestinal permeability of patients with chronic cholecystitis is higher than that of patients with acute appendicitis, and it can not be explained by the level of inflammatory factors.

Key words： Acute Appendicitis; Chronic Appendicitis; Intestinal Mucosal Function; Inflammatory Factors

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引用本文

陈雪峰, 丁倩男, 朱烨柯, 祝胜美, 李玉红, 急性阑尾炎和慢性胆囊炎术前和术中肠粘膜通透性的比较[J]. 国际临床研究杂志, 2021; 5: (4) : 1-8.

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