食管胃底静脉曲张破裂出血患者血浆 D-乳酸、二胺氧化酶和内毒素水平变化及临床意义

摘要

[目的]探讨血D-乳酸、二胺氧化酶（DAO）和内毒素水平在食管胃底静脉曲张破裂出血患者中的变化及其临床意义。[方法]将35例食管胃底静脉曲张破裂出血患者（Child-Pugh A级8例、B级13例，C组14例）和40例普通肝硬化患者分为试验组和对照组，采用鲎试剂基质偶氮显色法定量测定血浆中内毒素的含量，分光光度法测定血D-乳酸、DAO 含量。[结果]试验组外周血D-乳酸、DAO 和内毒素的活性分别为（17．58±3．69）mg/L、（8．13±1．12）U/mL、（0．89±0．19）EU/mL高于对照组（12．71±4．22）mg/L、（4．59±1．47）U/mL、（0．68±0．21）EU/mL（ P ＜0．05）。试验组外周血D-乳酸、DAO和内毒素活性组间比较：Child-Pugh A组（14．79±3．23）mg/L、（5．19±1．34）U/mL、（0．84±0．23）EU/mL低于Child-Pugh B组（17．79±3．86）mg/L、（7．89±1．78）U/mL、（1．03±0．17）EU/mL （ P ＜0．05）。Child-Pugh A、B组低于Child-Pugh C组（20．22±4．13）mg/L、（10．13±2．06）U/mL、（1．29±0．20）EU/mL（ P ＜0．05）。而Child-Pugh A组血D-乳酸、DAO与对照组相比无统计学意义。相关分析显示三者水平均相关。[结论]食管胃底静脉曲张破裂出血患者的内毒素血症发生率升高，伴有肠黏膜屏障功能障碍，且Child-Pugh分级存在正相关关系。%[Objective]To explore the change of plasma D-lactate ,diamine oxidase(DAO) and endotoxin in patients with esophageal and gastric variceal bleeding and its significance .[Methods] A total of 35 patients with esophageal and gastric variceal bleeding and 40 patients with liver cirrhosis were divided into experimental group and control group .Tachypleus amebocyte lysate substrate azo chromogenic assay was used for quantita-tive determination of plasma endotoxin .Spectrophotography was used to measure blood D-lactate and DAO .[Results] The activities of D-lactate ,DAO and endotoxin in peripheral blood of experimental group [(17 .58 ± 3 .69)mg/L ,(8 .13 ± 1 .12)U/mL and (0 .89 ± 0 .19)EU/mL ,respectively] were higher than those of control group[(12 .71 ± 4 .22)mg/L ,(4 .59 ± 1 .47)U/mL and (0 .68 ± 0 .21)EU/mL ,respectively ]( P <0 .05 or P<0 .01) .The activities of D-lactate ,DAO and endotoxin in peripheral blood of Child-Pugh A group[(14 .79 ± 3 .23)mg/L ,(5 .19 ± 1 .34)U/mL and (0 .84 ± 0 .23)EU/mL ,respectively ] were lower than those of Child-Pugh B in the experimental group[(17 .79 ± 3 .86)mg/l ,(7 .89 ± 1 .78)U/mL and (1 .03 ± 0 .17)EU/mL ,re-spectively]( P <0 .05) ,and those of Child-Pugh A group and Child-Pugh B group were lower than those of Child-Pugh C group[(20 .22 ± 4 .13)mg/L ,(10 .13 ± 2 .06)U/mL and (1 .29 ± 0 .20)EU/mL ,respectively] ( P <0 .05) .There was no significant difference in D-lactate and DAO between Child-Pugh A group and con-trol group .The correlative analysis showed that there were relationships among D-lactate ,DAO and endotox-in .[Conclusion]The incidence of endotoxemia in patients with esophageal and gastric variceal bleeding increa-ses ,and is accompanied by intestinal barrier function disorder ,and positively correlated with Child-Pugh grad-ing .