欢迎来到OAJRC平台!

期刊目次

加入编委

期刊订阅

添加您的邮件地址以接收即将发行期刊数据:

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;

发布时间: 2021-11-09 总浏览量: 265

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

参考文献 References

[1] 李进. 腹腔镜手术对胆囊结石合并急性胆囊炎患者机体应激及免疫功能的影响[J]. 河北医学, 2017(9).

[2] 任晓萌. 人胆囊炎致病菌对豚鼠肠道屏障及其结构蛋白的影响[D].

[3] 陆磊, 金旭文, 王翬,等. 腹腔镜与开腹胆囊切除术对急性结石性胆囊炎患者肠屏障功能的影响[J]. 中国微创外科杂志, 2018, v.18;No.207(06):49-53.

[4] 高志兴, 杨玉, 徐贵所. 头孢他啶与酪酸梭菌活菌胶囊对急性阑尾炎患者微创术后的胃肠功能的恢复及其对炎症因子水平的影响[J]. 抗感染药学, 2019, 16(02):122-124.

[5] Li Y, Yi S, Zhu Y, Hahn RG. Volume kinetics of Ringer's lactate solution in acute inflammatory disease[J]. Br J Anaesth, 2018,121(3):574-580. 

[6] Li Y, Xiaozhu Z, Guomei R, et al. Effects of vasoactive drugs on crystalloid fluid kinetics in septic sheep[J]. PLoS One, 2017, 12: e0172361.

[7] Wang W, Li Z, Meng Q, Zhang P, et al. Chronic Calcium Channel Inhibitor Verapamil Antagonizes TNF-α- Mediated Inflammatory Reaction and Protects Against Inflammatory Arthritis in Mice[J]. Inflammation, 2016, 39(5): 1624-1634. 

[8] Lee YM, Song BC, Yeum KJ. Impact of Volatile Anesthetics on Oxidative Stress and Inflammation[J]. Biomed Res Int, 2015,2015:242709.

[9] 杨学时. WBC计数和血清C-反应蛋白在阑尾炎的诊断及病情评估中的价值[J]. 中国卫生检验杂志, 2019, 029(004):435-437.

[10] 穆庆平, 刘毅, 徐玉珩, 等. 黄芪对全身炎症反应综合征患者肠屏障功能保护作用的临床研究[J]. 中国中医药科技, 2016, 23(2):143-145.

[11] Puleo F, Arvanitakis M, Van GA, et al. Gut failure in the ICU[J]. Semin Respir Crit Care Med, 2011, 32:626-638. 

[12] Zhu G, Li Y, Ru G, et al. Comparison of the hemodynamics and dynamics of fluid shift of Ringer's solution before surgery in children and adults[J]. Exp Ther Med, 2017, 13(6):3146-3152. 

[13] Lowell JA, Schifferdecker C, Driscoll DF, et al. Posto- perative fluid overload: not a benign problem[J]. Crit Care Med, 1990,18(7):728-733.

[14] Weinberg L, Ianno D, Churilov L, et al. Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenect- omy: A prospective multicentre randomized controlled trial[J]. PLoS One, 2017,12(9):e0183313. 

[15] Zhi X, Tao J, Li Z, et al. MiR-874 promotes intestinal barrier dysfunction through targeting AQP3 following intestinal ischemic injury[J]. FEBS Letters, 2014, 588(5): 757-763. 

[16] Lau E, Marques C, Pestana D, et al. The role of I-FABP as a biomarker of intestinal barrier dysfunction driven by gut microbiota changes in obesity[J]. Nutr Metab (Lond), 2016,13:31. 

[17] Earley ZM, Akhtar S, Green SJ, et al. Burn Injury Alters the Intestinal Microbiome and Increases Gut Permeability and Bacterial Translocation[J]. PLoS ONE, 2015, 10:e0129996. 

[18] Bischoff SC, Barbara G, Buurman W, et al. Intestinal permeability--a new target for disease prevention and therapy[J]. BMC Gastroenterol, 2014,14:189. 

[19] Yoseph BP, Klingensmith NJ, Liang Z, et al. Mechanisms of Intestinal Barrier Dysfunction in Sepsis[J]. Shock, 2016,46(1):52-59.

[20] Treskes N, Persoon AM, van Zanten ARH. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis[J]. Intern Emerg Med, 2017,2(6):821-836. 

[21] Aquino RS, Teng YH, Park PW. Glycobiology of syndecan-1 in bacterial infections[J]. Biochem Soc Trans, 2018,46(2):371-377. 

[22] Yablecovitch D, Oren A, Ben-Horin S, et al. Soluble Syndecan-1: A Novel Biomarker of Small Bowel Mucosal Damage in Children with Celiac Disease [J]. Dig Dis Sci, 2017,62(3):755-760. 

[23] Bertrand J, Bollmann M. Soluble syndecans: biomarkers for diseases and therapeutic options[J]. Br J Pharmacol, 2019,176(1):67-81.

[24] De Haan JJ, Lubbers T, Derikx JP, et al. Rapid d\evelopment of intestinal cell damage following severe trauma: a prospective observational cohort study[J]. Critical Care, 2009, 13(3): R86. 

[25] Montagnana M, Danese E, Lippi G. Biochemical markers of acute intestinal ischemia: possibilities and limitations[J]. Ann Transl Med, 2018,6(17):341. 

[26] 任晓萌. 人胆囊炎致病菌对豚鼠肠道屏障及其结构蛋白的影响[D]. 2016.

[27] Jones C, Badger SA, Regan M, et al. Modulation of gut barrier function in patients with obstructive jaundice using probiotic LP299v[J]. Eur J Gastroenterol Hepatol, 2013,25(12):1424-1430.

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.