Halme L, Turunen U, Tuominen J, Forsström T, Turpeinen U
Fourth Department of Surgery, Helsinki University Hospital, Finland.
Scand J Clin Lab Invest. 2000 Dec;60(8):695-701. doi: 10.1080/00365510050216420.
Increased intestinal permeability has been proposed as one aetiological factor for inflammatory bowel diseases (IBD). We have previously found that intestinal permeability of a water-soluble contrast medium, iohexol, correlates with disease activity. The objective was to compare the iohexol test with the lactulose-mannitol ratio, which is a more extensively studied permeability marker, in patients with active IBD. Urinary excretion of iohexol was compared to the lactulose-mannitol ratio in 22 patients with an exacerbation of IBD and in 10 healthy controls. Median intestinal absorption of iohexol was 0.64% (range 0.13-3.8%) in the 22 patients and 0.3% (range 0.15-0.54%) in the controls (p = 0.016), whereas the median lactulose-mannitol ratio was 0.037 (range 0.01-0.260) in patients and 0.03 (range 0.004-0.063) in controls (N.S.). Correlation between urinary excretion of iohexol and lactulose-mannitol ratio was positive (R = +0.41, p = 0.018). The urinary excretion of iohexol correlated positively with endoscopic disease activity (R = +0.74, p < 0.001) and the modified Harvey-Bradshaw index (R = +0.44, p = 0.04). The lactulose-mannitol ratio correlated positively with endoscopic disease activity (R = +0.44, p = 0.05), but correlations with clinical index or c-reactive protein were poor. In conclusion, the iohexol test is a superior activity marker compared to the lactulose-mannitol ratio which probably reflects, instead, some pathogenic property of IBD.
肠道通透性增加已被认为是炎症性肠病（IBD）的一个病因。我们之前发现，水溶性造影剂碘海醇的肠道通透性与疾病活动度相关。目的是在活动性IBD患者中比较碘海醇试验与乳果糖-甘露醇比值，后者是一种研究更为广泛的通透性标志物。比较了22例IBD病情加重患者和10名健康对照者碘海醇的尿排泄量与乳果糖-甘露醇比值。22例患者碘海醇的肠道吸收中位数为0.64%（范围0.13 - 3.8%），对照组为0.3%（范围0.15 - 0.54%）（p = 0.016），而患者乳果糖-甘露醇比值中位数为0.037（范围0.01 - 0.260），对照组为0.03（范围0.004 - 0.063）（无统计学意义）。碘海醇尿排泄量与乳果糖-甘露醇比值呈正相关（R = +0.41，p = 0.018）。碘海醇尿排泄量与内镜下疾病活动度呈正相关（R = +0.74，p < 0.001）以及与改良的Harvey - Bradshaw指数呈正相关（R = +0.44，p = 0.04）。乳果糖-甘露醇比值与内镜下疾病活动度呈正相关（R = +0.44，p = 0.05），但与临床指标或C反应蛋白的相关性较差。总之，与乳果糖-甘露醇比值相比，碘海醇试验是一种更优的活动度标志物，而乳果糖-甘露醇比值可能反映的是IBD的一些致病特性。
