Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment ad...Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.展开更多
目的探讨血清肠型脂肪酸结合蛋白(I-FABP),二胺氧化酶(DAO)对脓毒症患者早期肠组织损伤及预后的评估价值。方法选择2019年4~12月于同济大学附属同济医院急诊科收治的80例脓毒症患者及40例同期健康体检者(对照组)。脓毒症患者又根据急性...目的探讨血清肠型脂肪酸结合蛋白(I-FABP),二胺氧化酶(DAO)对脓毒症患者早期肠组织损伤及预后的评估价值。方法选择2019年4~12月于同济大学附属同济医院急诊科收治的80例脓毒症患者及40例同期健康体检者(对照组)。脓毒症患者又根据急性胃肠损伤分级(AGI)分为非AGI组(n=35),AGI组(n=45)。根据入院28天内死亡情况,将患者分为存活组(n=51)与死亡组(n=29)。比较各组患者血清I-FABP,DAO及其他临床特征,采用logistic回归分析脓毒症患者28天内预后的危险因素。结果与对照组比较,非AGI组和AGI组患者I-FABP(20.28±3.37,26.15±4.67μg/L vs 17.16±2.44μg/L),DAO(2.49±0.63,3.28±0.87mmol/L vs 1.31±0.34 mmol/L)水平升高(F=65.92,94.24,P<0.05);与非AGI组比较,AGI组I-FABP,DAO水平亦显著升高(P<0.05)。I-FABP,DAO与CRP,D-乳酸呈显著正相关(r=0.415,0.477,0.426和0.465,均P<0.05),而与TNF-α,IL-6无明显相关性(P>0.05)。与存活组比较,死亡组年龄较大,MV时间明显延长,CRP,PCT,APACHE Ⅱ评分,SOFA评分,AGI评分,I-FABP,DAO显著升高(t=2.27~11.21,均P<0.05)。多因素logistic回归分析显示,APACHE Ⅱ评分(OR=3.13,95%CI:1.67~4.48),AGI分级(OR=2.36,95%CI:1.38~3.49),I-FABP(OR=1.73,95%CI:1.24~2.51),DAO(OR=1.42,95%CI:1.13~1.84)均是28天内死亡的独立危险因素(χ^2=9.37~20.67,均P<0.05)。结论脓毒症患者血清I-FABP和DAO明显升高,与CRP和D-乳酸间有良好相关性,可反映早期肠组织损伤,有效预测脓毒症患者预后。展开更多
文摘Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.
文摘目的探讨血清肠型脂肪酸结合蛋白(I-FABP),二胺氧化酶(DAO)对脓毒症患者早期肠组织损伤及预后的评估价值。方法选择2019年4~12月于同济大学附属同济医院急诊科收治的80例脓毒症患者及40例同期健康体检者(对照组)。脓毒症患者又根据急性胃肠损伤分级(AGI)分为非AGI组(n=35),AGI组(n=45)。根据入院28天内死亡情况,将患者分为存活组(n=51)与死亡组(n=29)。比较各组患者血清I-FABP,DAO及其他临床特征,采用logistic回归分析脓毒症患者28天内预后的危险因素。结果与对照组比较,非AGI组和AGI组患者I-FABP(20.28±3.37,26.15±4.67μg/L vs 17.16±2.44μg/L),DAO(2.49±0.63,3.28±0.87mmol/L vs 1.31±0.34 mmol/L)水平升高(F=65.92,94.24,P<0.05);与非AGI组比较,AGI组I-FABP,DAO水平亦显著升高(P<0.05)。I-FABP,DAO与CRP,D-乳酸呈显著正相关(r=0.415,0.477,0.426和0.465,均P<0.05),而与TNF-α,IL-6无明显相关性(P>0.05)。与存活组比较,死亡组年龄较大,MV时间明显延长,CRP,PCT,APACHE Ⅱ评分,SOFA评分,AGI评分,I-FABP,DAO显著升高(t=2.27~11.21,均P<0.05)。多因素logistic回归分析显示,APACHE Ⅱ评分(OR=3.13,95%CI:1.67~4.48),AGI分级(OR=2.36,95%CI:1.38~3.49),I-FABP(OR=1.73,95%CI:1.24~2.51),DAO(OR=1.42,95%CI:1.13~1.84)均是28天内死亡的独立危险因素(χ^2=9.37~20.67,均P<0.05)。结论脓毒症患者血清I-FABP和DAO明显升高,与CRP和D-乳酸间有良好相关性,可反映早期肠组织损伤,有效预测脓毒症患者预后。
