| Objective:To study the diagnosis and early warning value of serum citrulline and glutathione S transferase at different time points on intestinal barrier dysfunction.To monitor the changes of serum citrulline and glutathione S transferase at different time points after abdominal operation.Methods:Detection of 41 cases of abdominal surgery patients including:24 patients with gastrointestinal malignancies treated,8 cases of patients with hepatic resection,4 cases of pancreaticoduodenal resection,5 patients with high bile duct carcinoma treated patients.Respectively to extract these patients with preoperative and postoperative 48 hours for 12 hours,24 hours after operation,postoperative peripheral blood,measuring serum a-GST,citrulline,established the index at different time points;At the same time,the detection of the peripheral blood escherichia coli 16SDNAqPCR,the change curve of two indicators and the peak level of each index and the optimal detection time point were described.To evaluate whether there were intestinal barrier dysfunction in 41 patients and the value of the above indicators in the diagnosis and early warning of intestinal barrier dysfunction at various time points.Results:1.Clinical evaluation of intestinal barrier dysfunction.Based on the diagnostic criteria of intestinal barrier dysfunction,the following conclusions were obtained:in the 12 hours after surgery,there were 22 cases of intestinal barrier dysfunction in 19 patients,and there were no intestinal barrier dysfunction in 22 cases.24 hours after surgery,there are 17 cases with residual 24 cases of intestinal barrier dysfunction occurs,48 h after surgery occurred in 7 cases of intestinal barrier dysfunction remaining 34 cases of intestinal barrier dysfunction does not occur.None of the 41 patients had died.2.Serum citrulline test results.:The mean value of preoperative and postoperative 12h,24h after operation and 48h after operation was respectively.24.18±6.82μmol/L、19.99±6.77μmol/L、14.60±5.57μmol/L、11.46±4.56μmol/L.There were statistically significant differences between preoperative and postoperative 12h,24h and 48h.(P<0.05)There was a continuing decline after surgery.Logistic regression analysis and ROC curve analysis were conducted.The area under the ROC curve.Postoperative 12h,24h and 48h were respectively.0.548(p=0.601)、0.723(p=0.016)、0.386(p=0.324)And citrulline has the highest diagnostic value for intestinal barrier dysfunction in 24 hours.The best detection threshold is.12.15pμmol/L Specific 83.3%sensitivity 64.7%.There is no warning value for 48 hours of intestinal barrier dysfunction.3.Serum alpha-gst test results.The mean value of preoperative and postoperative 12h,24h after operation and 48h after surgery were respectively.2.78±1.49ng/ml、3.49±1.62ng/ml、4.77±2.73ng/ml、3.05±1.56ng/ml.The concentration was increased at 12h after operation,and the peak was 24h after surgery,and 48h after surgery was decreased and was close to preoperative level.The difference was statistically significant between preoperative and postoperative 12h and 24h after operation.p<0.05.However,there was no statistically significant difference between the preoperative period and 48h after the operation,and the difference between 12h and 48h after surgery.(p>0.05)Logistic regression analysis and ROC curve analysis were conducted.The area under the ROC curve of a-gst was 12h,24h and 48h after surgery.0.718(p=0.017)、0.500(p=1.000)、0.413(0.449)Among them,a-GST has some significance in the evaluation of intestinal barrier dysfunction after 12h operation.The area under the ROC curve was 0.718.The optimal detection threshold was 3.66ng/ml,specificity 72.7%and sensitivity:68.4%.The area under the ROC curve of 24h intestinal barrier dysfunction was 0.875(p=0.008),the specificity was 75%,and the sensitivity was 100%.The warning value is high.There was no warning value for the area under the ROC curve of the early warning of 48 hours of intestinal barrier dysfunction,which was 0.541(p=0.784).4.Real-time fluorescence quantitative PCR results of escherichia coli 16SrDNA.The PCR copy number of 4 different time points of all 41 patients was performed before and after the operation,24h after surgery and 48h after surgery(log 10 after logarithm).6.04±0.45copies/μL、6.70±6.81 copies/μL、6.50±0.61copies/μL、6.51±0.63copies/μLIt can reach a peak in 12 hours after surgery,and it starts to decline 24 hours after surgery,and it enters the plateau within 48 hours after surgery.16 sdnaqpcr copy number in the preoperative and postoperative two comparison shows three time points:preoperative and postoperative respectively for 12 hours,24 hours after operation and postoperative 12 hours and after 24 hours,after 24 hours and after 48 hours between the difference was statistically significant(p<0.05).The remaining preoperative and postoperative 48 hours had no statistically significant difference between 12 and 48 hours after surgery.(p>0.05Conclusion:Serum citrate and glutathione S transferase have certain diagnostic value in early intestinal barrier dysfunction after abdominal operation.Among them,the serum citrate concentration was the best in the 24 hours after operation,and the area under the ROC curve was 0.723.The optimal detection threshold was 12.15,mol/L,specificity:83.3%,sensitivity:64.7%.However,it was found that the concentration of a-gst was the best in 12 hours after surgery,and the area under the ROC curve was 0.718.The optimal detection threshold was 3.66ng/ml,specificity 72.7%and sensitivity:68.4%.For the early warning of the intestinal barrier dysfunction of 24 hours,the area under the ROC curve was 0.875(p=0.008),and the optimal monitoring threshold was 2.50 ng/ml sensitivity 100%and specificity 75%. |
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