Hong Jiwon, Gilder Eileen, Blenkiron Cherie, Jiang Yannan, Evennett Nicholas J, Petrov Maxim S, Phillips Anthony R J, Windsor John A, Gillham Michael
School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand; Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
J Surg Res. 2017 May 1;211:21-29. doi: 10.1016/j.jss.2016.12.001. Epub 2016 Dec 9.
Nonocclusive mesenteric ischemia can cause intestinal infarction but the diagnosis is challenging. This prospective study evaluated three plasma biomarkers of intestinal infarction after cardiac surgery.
Patients were recruited after cardiac surgery if they required laparotomy (with or without intestinal resection) for suspected nonocclusive mesenteric ischemia. Plasma levels of D-lactate, intestinal fatty acid-binding protein (i-FABP), and smooth muscle actin (SMA) before laparotomy were measured.
Twenty patients were recruited (68 ± 9 y, EuroSCORE: 8.7 ± 2.8, mortality 70%). A positive laparotomy (n = 13) was associated with no change in D-lactate (P = 0.95), decreased i-FABP (P = 0.007), and increased SMA (P = 0.01). All patients with high SMA had a positive laparotomy. A subgroup analysis was undertaken in the eight patients who required multiple laparotomies. D-lactate increased between the two laparotomies in nonsurvivors (n = 4). Plasma i-FABP (P = 0.008) and SMA (P = 0.036) significantly decreased after the bowel resection, regardless of survival outcome.
None of the biomarkers were accurate enough to reliably diagnose intestinal infarction. However, all patients with high values of SMA developed intestinal infarction, thus warranting further investigation. An increasing D-lactate after intestinal resection suggests impending death.
非闭塞性肠系膜缺血可导致肠梗死，但诊断具有挑战性。本前瞻性研究评估了心脏手术后肠梗死的三种血浆生物标志物。
心脏手术后，若患者因疑似非闭塞性肠系膜缺血而需要剖腹手术（有或无肠切除术），则将其纳入研究。测量剖腹手术前血浆中D - 乳酸、肠脂肪酸结合蛋白（i - FABP）和平滑肌肌动蛋白（SMA）的水平。
共纳入20例患者（年龄68±9岁，欧洲心脏手术风险评估系统评分：8.7±2.8，死亡率70%）。剖腹手术阳性（n = 13）与D - 乳酸无变化（P = 0.95）、i - FABP降低（P = 0.007）和SMA升高（P = 0.01）相关。所有SMA高的患者剖腹手术均为阳性。对8例需要多次剖腹手术的患者进行了亚组分析。非幸存者（n = 4）在两次剖腹手术之间D - 乳酸升高。无论生存结果如何，肠切除术后血浆i - FABP（P = 0.008）和SMA（P = 0.036）均显著降低。
没有一种生物标志物足够准确可靠地诊断肠梗死。然而，所有SMA值高的患者均发生了肠梗死，因此值得进一步研究。肠切除术后D - 乳酸升高提示即将死亡。
