Liverani E, Silveri N G, Gasbarrini G, Mingrone G
Department of Internal Medicine, Catholic University, Rome, Italy.
Hepatogastroenterology. 2000 Jul-Aug;47(34):1037-41.
BACKGROUND/AIMS: Increased intestinal permeability was found in humans after multiple trauma, burn injury and major vascular surgery. However, no data are reported regarding possible correlation between trauma and intestinal permeability degree. This study was undertaken to compare gas-liquid chromatographic and enzymatic method for the evaluation of intestinal permeability impairment in patients after severe abdominal trauma.
Five traumatized patients with an injury severity score of more than 24 and 5 cross-matched healthy volunteers were studied. The intestinal permeability was performed using a test solution, containing 10 g lactulose and 5 g mannitol. Gas-liquid chromatographic method was applied to measure sugar standards and 5-hour urine samples and the results were compared with those obtained employing a specific enzymatic method.
Linearity of myoinositol, lactulose and mannitol measured by gas-liquid chromatographic method was from 0.2-1 microgram injected. Using the enzymatic method, the response was linear between mannitol concentrations of 0.34 and 5.49 mM. Linearity of lactulose standard was from 0.18-2.92 mM. The gas-liquid chromatographic and enzymatic methods showed a good agreement using the Bland-Altman procedure. The mean lactulose/mannitol ratio was 0.085 +/- 0.025 in patients and 0.009 +/- 0.001 in controls (P < 0.001). The higher the injury severity score (30.8 +/- 5) the larger the ratio of lactulose to mannitol (R2 = 0.74).
The enzymatic method--inexpensive, easy-to-perform and timesaving--is suitable for intestinal permeability studies. An abdominal trauma, without injury requiring surgical operation, modifies the intestinal mucosa permeability possibly favoring passage of bacteria and subsequent sepsis.
背景/目的：在多发伤、烧伤和大血管手术后，人体肠道通透性会增加。然而，尚无关于创伤与肠道通透性程度之间可能相关性的数据报道。本研究旨在比较气相色谱法和酶法评估严重腹部创伤患者肠道通透性损害的情况。
对5名损伤严重程度评分超过24分的创伤患者和5名交叉配型的健康志愿者进行研究。使用含有10克乳果糖和5克甘露醇的测试溶液检测肠道通透性。采用气相色谱法测量糖标准品和5小时尿液样本，并将结果与采用特定酶法获得的结果进行比较。
气相色谱法测量的肌醇、乳果糖和甘露醇的线性范围为注入量0.2 - 1微克。采用酶法时，甘露醇浓度在0.34至5.49毫摩尔之间时响应呈线性。乳果糖标准品的线性范围为0.18 - 2.92毫摩尔。气相色谱法和酶法经布兰德-奥特曼方法显示具有良好的一致性。患者的平均乳果糖/甘露醇比值为0.085±0.025，对照组为0.009±0.001（P < 0.001）。损伤严重程度评分越高（30.8±5），乳果糖与甘露醇的比值越大（R2 = 0.74）。
酶法价格低廉、操作简便且省时，适用于肠道通透性研究。腹部创伤，若无需手术治疗，可能会改变肠道黏膜通透性，从而可能有利于细菌通过并引发败血症。
