Department of Surgery, UCL Institute of Child Health, London, UK.
Department of Surgery, UCL Institute of Child Health, London, UK.
J Surg Res. 2014 Oct;191(2):323-30. doi: 10.1016/j.jss.2014.04.020. Epub 2014 Apr 15.
Despite emergence of markers of intestinal mucosal damage such as intestinal fatty-acid binding protein (i-FABP), there are no specific markers of damage extending into the muscle layers. We hypothesized that smooth muscle actin (SMA) released from the intestinal muscularis would be detectable in plasma after severe intestinal injury.
Serial blood samples were collected from rats (n = 10) undergoing intestinal ischemia-reperfusion injury (IRI) and controls (n = 5). Additionally, admission and/or preoperative plasma samples were collected from twelve neonates with necrotizing enterocolitis (NEC), and five age- and weight-matched controls. Plasma ileal fatty-acid binding protein (rat) or i-FABP (human) were measured by enzyme-linked immunosorbent assay, and plasma SMA was detected by western blotting.
Plasma ileal fatty-acid binding protein was low in both the control group and IRI at baseline, but became rapidly elevated in the IRI group even during ischemia. SMA was detected in reperfusion plasma samples of all IRI rats, but in none of the control samples. Plasma i-FABP was higher in infants with NEC than age- and weight-matched controls. Although i-FABP was higher in infants with severe surgical disease compared with focal disease, there was no difference between the operative and nonoperative groups. SMA was detected in the plasma of all four neonates with severe surgical NEC, but not in those with focal disease or those who were successfully conservatively managed.
SMA is detectable in plasma after severe intestinal injury and maybe a clinically useful maker of intestinal muscle damage.
尽管出现了肠黏膜损伤的标志物，如肠脂肪酸结合蛋白（i-FABP），但尚无延伸至肌肉层的损伤的特异性标志物。我们假设，严重肠损伤后，平滑肌肌动蛋白（SMA）会从肠肌层释放到血浆中。
对经历肠缺血再灌注损伤（IRI）的大鼠（n=10）和对照组（n=5）进行了连续采血。此外，从 12 例坏死性小肠结肠炎（NEC）新生儿和 5 名年龄和体重匹配的对照者中采集入院和/或术前的血浆样本。通过酶联免疫吸附试验测定血浆回肠脂肪酸结合蛋白（大鼠）或 i-FABP（人），通过 Western blot 检测血浆 SMA。
在对照组和 IRI 的基线时，血浆回肠脂肪酸结合蛋白均较低，但在 IRI 组中，即使在缺血期间，其水平也迅速升高。在所有 IRI 大鼠的再灌注血浆样本中均检测到 SMA，但在对照组样本中均未检测到。NEC 婴儿的血浆 i-FABP 高于年龄和体重匹配的对照组。尽管与局灶性疾病相比，严重手术性疾病的婴儿的 i-FABP 更高，但手术组和非手术组之间无差异。在 4 例严重手术性 NEC 新生儿的血浆中均检测到 SMA，但在局灶性疾病或成功保守治疗的患儿中未检测到 SMA。
严重肠损伤后可在血浆中检测到 SMA，它可能是一种有用的肠肌损伤的临床标志物。
