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Objective:To explore the effect of pectin on improving intestinal barrier injury in elderly stroke patients.Methods:A total of 60 elderly stroke patients who received enteral nutrition in Department of Critical Care Medicine of Taizhou People's Hospital from November 2020 to October 2021 were included. The control group included 30 cases, using conventional enteral nutrition solution. The other 30 cases were in the study group, and pectin was added on the basis of routine enteral nutrition solution. The levels of serum diamine oxidase (DAO) and D-lactic acid (D-LA) were measured on the first and 7th days of enteral nutrition to evaluate the intestinal barrier function of elderly stroke patients. The levels of interleukin-6 (IL-6), procalcitonin (PCT) and high-sensitivity C-reactive protein (CRP) were measured to evaluate the inflammatory response level of elderly stroke patients. The clinical prognosis of the two groups was compared.Results:Compared with the control group, the values of DAO [(4.05±1.56)ng/mL] and D-LA [(6.11±2.20) μmol/L] in the study group were significantly lower than those in the control group on the 7th day (all P < 0.05). Also the levels of IL-6 [(15.43±12.53) ng/mL], PCT [(0.82±0.98) ng/mL] and CRP [(6.94±6.60) mg/L] in the study group were lower than those in the control group, and the difference between the two groups was statistically significant (all P < 0.05). Compared with the control group, the length of ICU stay and total length of hospital stay in the study group were shorter than those in the control group ( P<0.05), but there was no significant difference in the incidence of stroke-related pneumonia (16.7% vs. 30.0%) and 30-day mortality (16.7% vs. 20.0%) between the two groups ( P>0.05). Conclusions:The enteral nutrition with pectin supplementation can improve intestinal barrier function and reduce inflammatory response in elderly stroke patients.
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Objective To analyze the changes of levels of plasma diamine oxidase(DAO),D-lactate and endotoxin in children with different severity of hand-foot-mouth disease(HFMD),explore the changes of the function of intestinal mucosal barrier in children with HFMD,and investigate the sensitivity and early warning effect of the indexes described previously on the damage of intestinal mucosal barrier in children with severe HFMD.Methods Four hundred and seventy inpatient children in Xi′an Children′s Hospital from March 2016 to June 2017 suffered from HFMD were selected as the study group,and one hundred healthy children were selected as the control group in the same period.Children in the study group were divided into common group(n=300),severe group(n=110)and critical condition group(n=60)according to the sever-ity of the disease.The levels of plasma DAO,D-lactate and endotoxin from children in each group were com-pared.Results The plasma D-lactate level of the children in the study group was significantly higher than that in the control group,and the difference was statistically significant[(27.670 ± 6.273)mg/L vs.(25.585 ± 5.177)mg/L;t=3.515,P<0.05];but the differences of DAO and endotoxin compared with the control group were not statistically significant[(3.205 ± 0.956)U/L vs.(3.135 ± 0.884)U/L,P>0.05;(1.186 ± 0.486)U/L vs.(1.091 ± 0.494)U/L,P>0.05].The comparison of multiple groups showed that the differ-ence of plasma D-lactate levels was statistically significant(F=33.488,P<0.05),while the differences of the levels of DAO and endotoxin were not statistically significant among different severity groups(F=0.709, F=2.296,P>0.05).The level of plasma D-lactate in critical condition group[(32.502 ± 4.756)mg/L]was significantly higher than those in the severe group[(29.872 ± 6.468)mg/L],the common group [(25.896 ± 5.691)mg/L] and the control group,and the differences were statistically significant(P <0.05);the difference in plasma D-lactate levels in the severe and non-severe groups was statistically signifi-cant(P<0.05),and the difference between common group and control group was not statistically significant (P>0.05).Conclusion The intestinal permeability and intestinal mucosal barrier are impaired in children with severe and critical HFMD.Plasma D-lactate is significantly elevated in the early stage of intestinal barri-er injury.Compared with DAO and endotoxin,D-lactate is a sensitive and early warning index suggesting the impaired intestinal mucosal barrier function in severe and critical cases of HFMD.
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Objective To evaluate the therapeutic effect of acupoint catgut embedding on gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury.Methods Sixty-eight consecutively hospitalized patients with gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury admitted to the Department of Intensive Care Unit (ICU) in the First Affiliated Hospital of Zhejiang University of Chinese Medicine from January 2015 to December 2015 were enrolled.Six of those patients were withdrawn from the course of observation,and actually only 62 patients entered the study.They were divided into an observation group (32 cases) and a control group (30 cases) by random number table.All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days.The observation group was additionally treated with acupoint catgut embedding.The control group took mosapride tablets via a nasogastric tube 5 mg,3 times a day.Intra-abdominal pressure (IAP),gastric residual volume (GRV),time for reaching standard enteral nutrition,serum diamine oxidase(DAO),D-Lactate activity,incidence of hospital-acquired pneumonia (HAP),hospitalization days in ICU,28-day mortality and adverse reactions of acupoint catgut embedding were observed in the two groups.Results After treatment,the levels of IAP,DAO,D-lactic acid were lower than those before treatment,GRV was less than that before treatment in the two groups,and after treatment for 7 days the changes were more significant in the observation group [IAP (cmH2O,1 cmH2O =0.098 kPa):12.42±3.11 vs.17.70 ± 2.98,GRV (mL):129.54 ± 57.54 vs.242.91 ± 99.29,DAO (U/L):9.06± 2.84 vs.13.60 ± 7.16,D-Lactate (mg/L):16.47 ± 5.39 vs.26.29 ± 9.62,all P < 0.01].Days of mechanical ventilation (days:6.97 ± 4.13 vs.9.23 ± 4.61),time for reaching standard enteral nutrition (days:4.25 ± 3.15 vs.5.50 ± 3.12) and hospitalization days in ICU (days:9.50± 4.03 vs.12.20 ± 6.38) in observation group were significantly shorter than those in control group (all P < 0.05).The incidence of HAP [15.6% (5/32) vs.40.0% (12/30)] and 28-day mortality [3.1% (1/32) vs.6.7% (2/30)] in observation group were obviously lower than those in control group.The patients in observation group had no significant adverse reactions of acupoint catgut embedding.Conclusions Acupoint catgut embedding therapy is not only easy to operate,but also can effectively improve gastrointestinal motility and intestinal barrier function in patients with gastrointestinal dysfunction after surgery of severe head injury,thus it is beneficial to reaching the enteral nutritional goal in less time,reducing the incidence of HAP,shortening the hospitalization time in ICU and promoting the recovery of the patients.
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Objective To explore the effect of hypoxic training on the barrier function of intestinal mucous membrane and underlying mechanism in rats.Methods Eighty 5-week-old male Sprague-Dawley rats were randomly divided into a control group,an exercise training group,a hypoxia control group and a hypoxia exercise group,each of 20.The altitude training was conducted through swimming training in artificial hypoxia environment.Two and 6 weeks after the intervention,the tissue structure and ultrastructure of small intestine mucosa were observed.The content of diamine oxidase (DAO)and D-lactate (D-LA),tumor necrosis factor-α (TNF-α)and nuclear factor κB (NF-κB)in plasma and the mRNA level of occludin in ileal tissue were measured.Results (1)Electron microscopy data showed that,after six weeks,compared with the control group,the microvilli of rats in the exercise training group were sparser and arranged irregularly.Furthermore,the gap between epithelial cells became wider.In addition,the number of mitochondria decreased significantly and cristae were vague.For the hypoxia control group,the microvilli shortened significantly and arranged irregularly.Moreover,the gap between cells became wider with partial denatured mitochondria.For the Hypoxia exercise group,the number of mucosal epithelium microvilli in the bowels reduced significantly and the microvilli shortened significantly.Similar to that of the hypoxia control group,the gap between epithelium cells growed wider.However,the cellular structure were fuzzier,and the denature of mitochondria worsened,with the cristae being vague even disappearing partially.(2)Two weeks of exercise training reduced the number of intestinal microvilli significantly (P<0.01),but increased the plasma level of the DAO and D-LA,as well as the expression level of NF-κB in intestinal tissue significantly (P<0.05).Hypoxic exposure significantly reduced the mRNA level of oceludin in small intestine (P<0.01),but significantly increased the plasma level of DAO and D-LA (P<0.05 vs.control)and the expression of TNF-α and NF-κB in small intestine (P<0.01).There was no significant interaction between two weeks of exercise training and hypoxia exposure either on the reduction of the number and height of intestinal microvilli,or the transcription level of occluding in small intestine,or the plasma level of DAO and D-LA,or the expression of TNF-α and NF-κB in small intestine (P>0.05).(3)Both exercise training for six weeks and hypoxia exposure significantly reduced the number and height of microvilli in small intestine (P<0.01)and the occludin level in small intestine,but significantly increased the plasma level of DAO and DLA (P<0.01),the expression of TNF-α (P<0.01,P<0.05)and NF-κB (P<0.01).Meanwhile there was significant interaction between six-week exercise training and hypoxia exposure on decreasing the number (P<0.01)and the height (P<0.05)of microvilli in small intestine.Conclusion (1)Both intensive training and hypoxia exposure can impair intestinal mucosal barrier function and the extent of damage is correlated with the duration of training and hypoxia exposure.(2)Hypoxic exposure and intensive training may reduce the expression of occludin mRNA through increasing the expression of TNF-α and NF-κB in the small intestine,which in turn increases intestinal permeability and intestinal mucosa inju
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Objective To observe the effect of Ulinastatin (UTI) on intestinal barrier function of elderly patients with sepsis in order to explore an optimized program of early treatment for such patients instituting a guidelines for clinical practice.Methods All selected patients randomly (ramdom number) divided into conventional treatment group (n =34) and UTI treatment group (n =34).Peripheral venous blood samples of elderly patients with sepsis were routinely taken at days 0,2,3,7 (D0,D2,D3,D7) after admission for detecting the changes of ptasma values of Intestinal fatty acid binding protein (IFABP),Diamine oxidase (DAO),and D-lactate (D-Lac).While patients' APACHE Ⅱscores,length of ICU stay and 28 d mortality also were recorded at the same time.Results At admission,there were no significant differences in patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac between two groups (P > 0.05).During the course of treatment,the patients' APACHE Ⅱscores,plasma values of IFABP,DAO and D-Lac were declining in both groups,while those declinations in UTI group showed significantly more prominent.Compared with conventional therapy group,IFABP level was significandy lower in UTI group (P < 0.05),and the plasma values of DAO and D-Lac were significantly lower at D2 and D3 in UTI group (P < 0.05),but not at D7 (P > 0.05).The plasma levels of IFABP,DAO and D-Lac were positively associated with APACHE Ⅱscores,but not with length of ICU-stay (P >0.05).After treatment,28d mortality did not differ significantly between the two groups (P >0.05).Conclusions UTI has a protective effect on intestinal barrier function in elderly patients with sepsis.UTI can improve the prognosis of elderly patients with sepsis and reduce ICU stay,while has no significant effect on reducing 28 d mortality.
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Objective To study the role of D‐lactate gradient across the lung in the rapid diagnosis of pneumonia and evalua‐tion of therapeutic efficacy .Methods Patients were divided into pneumonia group (n=46) and non‐pneumonia group (n=28) in ICU .D‐lactate gradient across the lung were calculated by the difference between arterial and mixed‐venous D‐lactate concentrations before the treatment ,after 3 and 7 days of treatment .Serum procalcitonin (PCT) ,Oxygenation index ,the lung injury score (LIS) and clinical pulmonary infection score(CPIS) were recorded at the same time .Results The mean D‐lactate gradient across the lung in pneumonia group was significantly higher than that in non‐pneumonia group[(163 .84 ± 10 .72) ng/mL vs .(30 .33 ± 7 .25) ng/mL ,P<0 .01) ]before treatment .Using a cut‐off value of 106 .11 ng/mL ,D‐lactate gradient across the lung′s sensitivity for di‐agnosis pneumonia was 90 .7% and its′specificity was 75 .5% .D‐lactate gradient across the lung correlated with LIS (r= 0 .554 , P<0 .01) and CPIS(r=0 .543 ,P<0 .01) .Conclusion D‐lactate gradient across the lung correlates with lung injury and pulmonary infection positively and may be a potential biomarker for rapid diagnosis of pneumonia .
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OBJECTIVE: It is essential to identify a serological marker of injury in order to study the pathophysiology of intestinal ischemia reperfusion. In this work, we studied the evolution of several serological markers after intestinal ischemia reperfusion injury in rats. The markers of non-specific cell damage were aspartate aminotransferase, alanine aminotransaminase, and lactic dehydrogenase, the markers of inflammation were tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta, and the markers of intestinal mucosal damage were intestinal fatty acid binding protein and D-lactate. We used Chiús classification to grade the histopathological damage. METHODS: We studied 35 Wistar rats divided into groups according to reperfusion time. The superior mesenteric artery was clamped for 30 minutes, and blood and biopsies were collected at 1, 3, 6, 12, 24, and 48 hours after reperfusion. We plotted the mean ± standard deviation and compared the baseline and maximum values for each marker using Student's t-test. RESULTS: The maximum values of interleukin-1 beta and lactic dehydrogenase were present before the maximal histopathological damage. The maximum tumor necrosis factor alpha and D-lactate expressions coincided with histopathological damage. Alanine aminotransaminase and aspartate aminotransferase had a maximum expression level that increased following the histopathological damage. The maximum expressions of interluken-6 and intestinal fatty acid binding protein were not significantly different from the Sham treated group. CONCLUSION: For the evaluation of injury secondary to acute intestinal ischemia reperfusion with a 30 minute ischemia period, we recommend performing histopathological grading, quantification of D-lactate, which is synthesized by intestinal bacteria and is considered an indicator of mucosal injury, and quantification of tumor necrosis ...
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Animales , Femenino , Ratas , Biomarcadores/sangre , Intestinos/irrigación sanguínea , Daño por Reperfusión/sangre , Aspartato Aminotransferasas/sangre , Biopsia , Citocinas/sangre , Modelos Animales de Enfermedad , Proteínas de Unión a Ácidos Grasos/sangre , Intestinos/patología , Lactato Deshidrogenasas/sangre , Ratas Wistar , Valores de Referencia , Factores de TiempoRESUMEN
BACKGROUND: The gut is capable of inducing multiple organ dysfunction syndrome (MODS). In the diagnosis and treatment of critical ill patients, doctors should pay particular attention to the protection or recovery of intestinal barrier function. However, no reliable diagnostic criteria are available clinically. This study aimed to assess the changes of intestinal mucosal barrier function in surgically critical ill patients as well as their significance. METHODS: Thirty-eight surgically critical ill patients were enrolled as a study group (APACHE II>8 scores), and 15 non-critical ill patients without intestinal dysfunction were selected as a control group (APACHE II<6). General information, symptoms, physical signs, and APACHE II scores of the patients were recorded. The patients in the study group were subdivided into an intestinal dysfunction group (n=26) and a non-intestinal dysfunction group (n=12). Three ml venous blood was collected from the control group on admission and the same volume of plasma was collected from the study group both on admission and in the period of recovery. The plasma concentrations of endotoxin, diamine oxidase (DAO), D-lactate, and intestinal fatty-acid binding protein (iFABP) were detected respectively. The data collected were analyzed by the SPSS 17.0 software for Windows. RESULTS: The levels of variables were significantly higher in the study group than in the control group (P<0.01). They were higher in the intestinal dysfunction group than in the non-intestinal dysfunction group (DAO P<0.05, endotoxin, D-lactate, iFABP P<0.01). In the non-intestinal dysfunction group compared with the control group, the level of endotoxin was not significant (P>0.05), but the levels of DAO, D-lactate and iFABP were statistically significant (P<0.05). The levels of variables in acute stage were higher than those in recovery stage (P<0.01).The death group showed higher levels of variables than the survival group (endotoxin and D-lactate P<0.01, DAO and iFABP P<0.05). CONCLUSION: The plasma concentrations of endotoxin, DAO, D-lactate, and intestinal fatty-acid binding protein (iFABP) could reflect a better function of the intestinal mucosa barrier in surgically critical ill patients.
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Objective To discuss the value of diagnosing gastrointestinal dysfunction in.critically ill children.Methods Seventy-six critically ill patients were reviewed,48 cases combined with gastrointestinal dysfunction.Plasma D-lactate,intestinal fatty acid binding protein(IFABP)of serum and urine were performed in all patients,detected the sensitivity and specificity,ealculated the area under the ROC curve (AUC).Results Plasma D-Iactate level≥9.63 mg/L had a sensitivity of 85.2%,specificity of 70.9%,and AUC of 0.822 for diagnosing gastrointestinal dysfunction.Serum IFABP level≥0.129μg/L had a sensitivity of 65.2%,specificity of 63.8%,and AUC of 0.744 for diagnosing gastrointestinal dysfunction.Urine IFABP ≥0.330μg/Lhad a sensitivity of 78.3%,specificity of 72.3%,and AUC of 0.820 for diagnosing gastrointestinal dysfunction.There was no significant difference in AUC between plasma and urine IFABP(P>0.05),there was no significant difference in AUC between serum D-lactate and serum IFABP(P>0.05).Conclusions Plasma D-Lactgte,serum and urine WABP may be useful markers as warning gastrointestinal dysfunction of critically ill children.Plasma D-lactate and urine IFABP level may be more sensitively,but they need to be further studied.
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Objective To observe the therapeutic effects of rude rhubarb on intestinal barrier in septic patients. Methods A total of 40 septic patients were enrolled in this study and randomly divided into two groups:rude rhubarb treatment group(a=18)and control group(n=22).The ratio of laetulose to mannitol(L/M)and D-lactate were determined on the first day and the 6th day after patients were enrolled.Results No signifieant differences were found on L/M and D-lactate in plasma on the first day between the rude rhubarb treatment group and the control group(P>0.05). The L/M on the 6th day in the eontrol group was(0.1674?0.0361),and that in the rude rhubarb treatment group was (0.0621?0.0128)(P<0.05).D-laetate in plasma in the 6 th day in the the rude rhubarb treatment group was(0.09?0.03)mmol/L,and was obviously lower than that in the control group(0.24?0.06)mmol/L(P<0.05). Conclusion Rude rhubarb can improve the intestinal barrier.
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Objective To study the potential role of tumor necrosis factor-α (TNF-α) induction in the development of mucosal barrier dysfunction in rats caused by acute intestinal ischemia-reperfusion injury, and to examine whether pretreatment with monoclonal antibody against TNF-α (TNF-α MoAb) would affect the release of D(-)-lactate after local gut ischemia followed by reperfusion. Methods Anesthetized Sprague-Dawley rats underwent superior mesenteric artery occlusion for 75 min followed by reperfusion for 6 hr. The rats were treated intravenously with either TNF-α MoAb (20 mg/kg) or albumin (20 mg/kg) 30 min prior to the onset of ischemia. Plasma D(-)-lactate levels were measured in both the portal and systemic blood by an enzymatic spectrophotometric assay. Intestinal TNF-αmRNA expression as well as protein levels were also measured at various intervals. In addition, a postmortem examination was performed together with a macropathological evaluation based on a four-grade scoring system.Results Intestinal ischemia resulted in a significant elevation in D(-)-lactate levels in the portal vein blood in both the control and treatment groups ( P <0.05). However, animals pretreated with TNF-α MoAb at 6 hr after reperfusion showed significant attenuation of an increase in both portal and systemic D(-)-lactate levels when compared with those only receiving albumin (P < 0.05). In the control animals, a remarkable rise in intestinal TNF-α level was measured at 0.5 hr after clamp release ( P < 0.01); however, prophylactic treatment with TNF-α MoAb completely annulled the increase of local TNF-α levels seen in the control animals. Similarly, after anti-TNF-α MoAb administration, intestinal TNF-α mRNA expression was markedly inhibited, which showed significant differences when compared with the control group at 0.5 hr, 2 hr and 6 hr after the release of occlusion ( P < 0.05-0.01 ). In addition, the pathological examination showed marked intestinal lesions that formed during ischemia, which were much worse upon reperfusion,particularly at the 6 hr time point. These acute injuries were obviously attenuated in animals receiving TNF-α MoAb.Conclusions It appeared that acute intestinal ischemia was associated with failure of the mucosal barrier, resulting in increased plasma D(-)-lactate levels in both portal and systemic blood. These results suggest that TNF-α appears to be involved in the development of local damage associated with intestinal ischemic injury. Moreover, prophylactic treatment with TNF-α MoAb exerts preventive effects on ischemia/ reperfusion-induced circulating D (-)-lactate elevation and gut injury. ( J Geriatr Cardiol 2004;1(2):119-124. )
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PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.
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Humanos , Desequilibrio Ácido-Base , Acidosis , Alcalosis Respiratoria , Antibacterianos , Insuficiencia Hepática , Cuerpo Humano , Ácido Láctico , Lactulosa , Hígado , Cirrosis Hepática , Metabolismo , PlasmaRESUMEN
Objective To explore the correlation analysis of plasma TNF-?,D-lactate levels and serious case score and clinical significance.Methods Plasma TNF-?,D-lactate levels and results from serious case'score was contrastingly studied in 120 cases of serious sick children during hospitalization in our PICU.Results The study findings showed that the plasma TNF-? and D-lactate levels had produced an obviously influence on score.Conclusions The more high plasma TNF-? and D-lactate levels,the lower score and the more dangerous condition in children with serious disease.
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Objective To investigate the changes of intestinal barrier function of patients with multiple injuries,and explore the relationship between the changes and Systemic Inflammatory Response Syndrome(SIRS).Methods Fifty two patients with multiple injury admitted to our hospital from Aug.2007 to May 2008 were divided into mild injury group(n=24,ISS0.05),while obvious increasing existed in moderate and severe groups at 1st day after trauma(P
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Objective To explore the changes of plasma endotoxin and D-lactate during intestinal mucosal barrier injury of acute pancreatitis.Methods Wistar rats were randomly divided into sham-operation(SO)group,and severe acute pancreatitis(SAP)group.Plasma endotoxin and D-lactate were determined at 1,3,6 and 12 hour after operations.Results The plasma endotoxin and D-lactate in SAP group increased obviously with time,and the difference betueen the 2 groups was significante(P
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0.05).Conclusions Serum DAO can be used as a sensitive marker to early diagnose gastrointestinal dysfunction in critical neonates.Serum D-lactate will be of high specific clinical significance in diagnosis,the change of D-lactate may have relations to the features of intestinal microflora in early neonates.