Cevikel Mehmet Hakan, Ozgün Hedef, Boylu Sükrü, Demirkiran Ahmet Ender, Aydin Neriman, Sari Cavide, Erkus Muhan
Department of General Surgery, Adnan Menderes University, Aydin, Turkey.
ANZ J Surg. 2004 Oct;74(10):900-4. doi: 10.1111/j.1445-1433.2003.02681.x.
C-reactive protein (CRP) is used as a marker of intestinal ischaemia. This study evaluated whether CRP levels can be used to detect ischaemia-induced (strangulated) intestinal obstruction and subsequent bacterial translocation.
Forty-eight rats, divided into four groups underwent the following procedures: anaesthesia alone (native controls), laparotomy (sham-operated controls), or surgical induction of simple or strangulated intestinal obstruction (simple and strangulated obstruction groups, respectively). Blood samples were collected for culture and serum CRP analysis. In addition, liver and mesenteric lymph node (MLN) specimens were collected for culture, to determine the presence of bacterial translocation; and ileal segments, for histopathological investigation.
CRP levels and rates of bacterial translocation, expressed as colony forming units (cfu) per gram wet tissue, were higher in both intestinal obstruction groups than in the native and sham-operated control groups (P < 0.001 for both). The increases in CRP levels paralleled increases in the number of cfu in the MLN and liver cultures (P < 0.01). Compared to controls, animals in the obstruction groups also had a higher incidence of positive blood cultures (P < 0.005) and greater histopathologic evidence of inflammatory infiltration of the lamina propria (P < 0.01). However, no significant difference between the simple and strangulated obstruction groups was observed.
CRP levels increase with the severity of bacterial translocation in acute intestinal obstruction but do not permit discrimination between simple and strangulated intestinal obstruction.
C反应蛋白(CRP)用作肠缺血的标志物。本研究评估了CRP水平是否可用于检测缺血性(绞窄性)肠梗阻及随后的细菌移位。
48只大鼠分为四组,分别接受以下操作:单纯麻醉(正常对照组)、剖腹术(假手术对照组),或手术诱导单纯性或绞窄性肠梗阻(分别为单纯性和绞窄性梗阻组)。采集血样进行培养及血清CRP分析。此外,采集肝脏和肠系膜淋巴结(MLN)标本进行培养,以确定细菌移位的存在;并采集回肠段进行组织病理学研究。
肠梗阻两组的CRP水平及以每克湿组织菌落形成单位(cfu)表示的细菌移位率均高于正常对照组和假手术对照组(两者P<0.001)。CRP水平的升高与MLN和肝脏培养物中cfu数量的增加平行(P<0.01)。与对照组相比,梗阻组动物血培养阳性发生率更高(P<0.005),且固有层炎症浸润的组织病理学证据更明显(P<0.01)。然而,单纯性和绞窄性梗阻组之间未观察到显著差异。
急性肠梗阻时CRP水平随细菌移位的严重程度增加,但无法区分单纯性和绞窄性肠梗阻。