Kong Wencheng, Wang Jian, Ping Xiaochun, Shen Jing, Ni Xiaodong, Liu Fangnan, Yu Baojun, Li Yousheng
Clin Lab. 2015;61(3-4):371-8. doi: 10.7754/clin.lab.2014.140712.
Chemotherapy-induced mucosal barrier dysfunction is of clinical interest. However, the assessment of mucosal barrier dysfunction still poses challenges. In this study, we compared several biomarkers with the dual sugar gut permeability test for assessing mucosal barrier dysfunction during chemotherapy.
Forty-two patients with gastric or colorectal cancer underwent chemotherapy, including FAM or FOLFOX4 regimens. Patients were asked to grade and record their symptoms of gastrointestinal toxicity daily. The urinary lactulose-mannitol ratio was measured to assess the intestinal permeability. Plasma levels of citrulline, diamine oxidase (DAO), D-lactic acid, and endotoxin were also measured. Intestinal permeability was observed in the subgroup of patients with diarrhea or constipation.
The urinary lactulose-mannitol ratio and plasma citrulline levels increased on the third and sixth post-chemotherapy days, respectively. There were no significant differences in the plasma levels of D-lactic acid, endotoxin or DAO activity compared to their levels before chemotherapy. The urinary lactulose-mannitol ratio in diarrhea patients was significantly higher than in constipation patients.
These results indicate that the urinary lactulose-mannitol ratio and plasma citrulline level are appropriate biomarkers for assessing mucosal barrier dysfunction in patients receiving chemotherapy. Mucosal barrier dysfunction in diarrhea patients was greater than in constipation patients.
化疗引起的黏膜屏障功能障碍具有临床研究价值。然而，黏膜屏障功能障碍的评估仍面临挑战。在本研究中，我们比较了几种生物标志物与双糖肠道通透性试验在评估化疗期间黏膜屏障功能障碍方面的作用。
42例胃癌或结直肠癌患者接受化疗，化疗方案包括FAM或FOLFOX4。患者被要求每天对胃肠道毒性症状进行分级并记录。测量尿乳果糖-甘露醇比值以评估肠道通透性。同时检测血浆中瓜氨酸、二胺氧化酶（DAO）、D-乳酸和内毒素水平。在腹泻或便秘患者亚组中观察肠道通透性。
化疗后第3天和第6天，尿乳果糖-甘露醇比值和血浆瓜氨酸水平分别升高。与化疗前相比，血浆D-乳酸、内毒素水平或DAO活性无显著差异。腹泻患者的尿乳果糖-甘露醇比值显著高于便秘患者。
这些结果表明，尿乳果糖-甘露醇比值和血浆瓜氨酸水平是评估化疗患者黏膜屏障功能障碍的合适生物标志物。腹泻患者的黏膜屏障功能障碍大于便秘患者。
