不同方法治疗后脓毒症患者的肠道通透性测定及比较

摘要

目的 建立用HPLC-ELSD法测定人肠道黏膜通透性的方法,同时应用此方法研究ICU脓毒症患者且治疗时间超过72 h者肠道屏障功能的变化.方法 采用HPLC-ELSD法对人尿液标本中乳果糖和甘露醇的含量测定进行方法学研究,检测9例常规治疗组和9例常规治疗结合针灸组尿液标本中甘露醇和乳果糖含量,并计算乳果糖/甘露醇的比值.结果 该方法使甘露醇和乳果糖得到良好分离.甘露醇的双对数线性方程为logy=1.2895logx+3.4952(r=0.9995),线性范围为39.65～2537.6 μg/mL,乳果糖的双对数线性方程为logy=1.0624(l)ogx+3.6359(r=0.9993),线性范围为25.05～1603 μg/mL;甘露醇和乳果糖日内精密度(RSD)分别为1.52％和1.95％;甘露醇和乳果糖的日间精密度(RSD)分别为1.59％和1.37％;重复性分别为1.04％和2.56％.甘露醇的平均加样回收率为99.51％,RSD=1.75％;乳果糖的平均加样回收率为98.45％,RSD=0.96％.常规治疗组患者第1日和第5日乳果糖排泄率/甘露醇排泄率分别为(0.920±0.0200)和(0.520±0.170),常规治疗结合针灸组患者第1日和第5日乳果糖排泄率/甘露醇排泄率分别为(1.410±0.5200)和(0.770±0.460).结论 HPLC-ELSD检测肠道通透性的准确度高、重复性好,样品前处理简单,是临床评价小肠黏膜屏障功能的实用方法.常规治疗结合针灸治疗能较好的改善人体肠道通透性.%objective: To establish a HPLC-ELSD method for the determination of intestinal mucosal permeability method,and applied this method to the study of ICU patients with sepsis and the duration of treatment than 72h intestinal barrier changes. Methods: the HPLC-ELSD method was used to research on human urine specimens of lactulose and mannitol content determination method study, the content of 9 cases of conventional treatment group and 9 cases of routine therapy combined with acupuncture in urine of mannitol and lactulose were determined , and the lactulose / mannitol ratio was calculated. Results: The method got good a separation of mannitol and lactulose. Mannitol double logarithmic linear equation was logy=1.28951ogx+3.4952 (r=0.9995) ,the linear range was 39.65 ~2537.6ug/mL,lactulose double logarithmic linear equations for logy=1.06241ogx+3. 6359 (r= 0.9993) ,the linear range was 25.05~1603 μg/mL;mannitol and lactulose within day precision (RSD) were 1.52% and 1.95% ;mannitol and lactulose day precision degree (RSD) were 1.59% and 1.37% ;reproducibility were 1.04% and 2.56%. Mannitol and the average recovery was 99.51% ,RSD=1. 75%,n = 9 lactulose;the average recovery was 98.45% ,RSD=0.96% ,n = 9. The conventional treatment group were first and fifth days of lactulose / mannitol excretion excretion rates were 0.920 0.0200 and 0.520 0.170 soil soil,routine therapy combined with acupuncture and moxibustion group were first and fifth days of lactulose / mannitol excretion excretion rates were 1.410 0.5200 and 0.770 0.460 soil soil. Conclusion: the HPLC-ELSD detection of intestinal permeability of high accuracy, good repeatability, simple sample pretreatment, is a clinical evaluation of intestinal mucosal barrier function method. From the results,the conventional treatment combined with acupuncture treatment can improve the human intestinal permeability.