Polk Jonathan D, Rael Leonard T, Craun Michael L, Mains Charles W, Davis-Merritt Deborah, Bar-Or David
Saint Joseph Hospital, Denver, Colorado, USA.
J Trauma. 2008 Jan;64(1):42-5. doi: 10.1097/TA.0b013e31815b846a.
Currently, the rapid diagnosis of mesenteric ischemia is problematic because of the nonspecificity of most laboratory assays and the unreliability of physical examinations. The evaluation of the cobalt-albumin binding assay (CABA) as a diagnostic marker for short-term risk stratification of emergency department patients presenting with symptoms of intestinal ischemia is reported. This preliminary study includes patients scheduled for exploratory laparotomy with symptoms of ischemic bowel and/or bowel obstruction. Approximately 10 mL of blood was drawn from each patient 1 hour preoperatively into a serum separator gel tube. After 30 minutes of clotting time, serum was collected and frozen at -80 degrees C. The CABA test was performed on the samples by an investigator blinded to the patient's condition, and values were compared with the clinical and pathologic diagnosis of ischemic bowel postoperatively. CABA test values are reported as absorbance units (ABSU) at 470 nm. Of the 26 patients enrolled in the study, 12 were clinically diagnosed with intestinal ischemia. These patients had significantly higher CABA test values (0.52 ABSU +/- 0.04 SEM) than patients without intestinal ischemia (0.31 ABSU +/- 0.02 SEM, p = 0.00023). Only two false-positives and no false-negatives were recorded. This resulted in a sensitivity of 100% and a specificity of 85.7% for the CABA test for these particular samples. The CABA test could be a useful tool for clinicians in the risk stratification of intestinal ischemia.
目前，由于大多数实验室检测缺乏特异性以及体格检查不可靠，肠系膜缺血的快速诊断存在问题。本文报告了对钴白蛋白结合试验（CABA）作为出现肠道缺血症状的急诊科患者短期风险分层诊断标志物的评估。这项初步研究纳入了计划进行剖腹探查术且有缺血性肠病和/或肠梗阻症状的患者。术前1小时从每位患者抽取约10 mL血液至含血清分离胶的试管中。凝血30分钟后，收集血清并在-80℃冷冻。由对患者病情不知情的研究人员对样本进行CABA检测，并将检测值与术后缺血性肠病的临床和病理诊断结果进行比较。CABA检测值以470 nm处的吸光度单位（ABSU）报告。在该研究纳入的26例患者中，12例临床诊断为肠道缺血。这些患者的CABA检测值（0.52 ABSU±0.04 SEM）显著高于无肠道缺血的患者（0.31 ABSU±0.02 SEM，p = 0.00023）。仅记录到两例假阳性，无假阴性。对于这些特定样本，CABA检测的灵敏度为100%，特异性为85.7%。CABA检测可能是临床医生对肠道缺血进行风险分层的有用工具。
