Yan X X, Zhang X, Ai H, Wang D, Song K Y
Intensive Care Unit, Bozhou People's Hospital Affiliated to Anhui University of Science and Technology, Bozhou 236800, China.
Zhonghua Yi Xue Za Zhi. 2019 Feb 12;99(6):442-446. doi: 10.3760/cma.j.issn.0376-2491.2019.06.012.
To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP) and the effect of early enteral nutrition on them. A single-center, single-sample, prospective, randomized controlled clinical trial was conducted. A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization. The two groups received equal calorie nutritional support, and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO) were detected immediately after admission and at 48 h, 72 h and 144 h. At the same time, the worst value of APACHE-Ⅱ score was recorded, and the correlation between DAO, D-LA and APACHE-Ⅱ score was analyzed. The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group. There was no statistical difference in gender, age, poisoning time and organophosphorus pesticide components between group A and B (0.05). The distribution of D-LA concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (66±19) μg/L, (68±21) μg/L, (66±19) μg/L, (63±17) μg/L, while in group B they were (62±15) μg/L, (58±17) μg/L, (58±16) μg/L, (67±9) μg/L. There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L, 0.05]. The distribution of DAO concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (2.1±0.6) μg/ml, (2.1±0.5) μg/ml, (2.2±0.4) μg/ml, (2.2±0.5) μg/ml, while in group B they were (2.1±0.5) μg/ml, (2.1±0.5) μg/ml, (2.2±0.5) μg/ml, (2.1±0.4) μg/ml. DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1±0.0 μg/ml) (0.05). There is no statistical difference in DAO concentration between group A and B at different time points (0.05). The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2+1.7, 5.5+2.1) was significantly lower than that in group B (14.1+2.4, 8.2+2.6) (0.05). D-LA, DAO concentration at different time points was not correlated with APACHE-Ⅱ score (0.05). D-LA (r, P) was immediate admission (-0.17, 0.24), 48 h (0.04, 0.79), 72 h (0.32, 0.06), 144 h (0.29, 0.07), and DAO (r, P) was immediate admission (-0.12, 0.43), 48 h (0.02, 0.92), 72 h (0.03, 0.85), 144 h (0.03, 0.82). Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h), but the intestinal permeability is normal. Early enteral nutrition therapy can promote the recovery of patients, but has low correlation with intestinal barrier function improvement.
观察急性重度有机磷农药中毒（ASOPP）患者肠道屏障功能的变化以及早期肠内营养对其的影响。进行了一项单中心、单样本、前瞻性、随机对照临床试验。将50例ASOPP患者按住院顺序分为24小时肠内营养组（A组）和48小时（48 - 72小时）肠内营养组（B组）。两组给予等热量营养支持，于入院时及48小时、72小时和144小时检测血清D - 乳酸（D - LA）和血清人二胺氧化酶（DAO）。同时记录APACHE - Ⅱ评分的最差值，并分析DAO、D - LA与APACHE - Ⅱ评分之间的相关性。检测15例健康成年人的血清D - LA和DAO浓度作为健康对照组。A组和B组在性别、年龄、中毒时间和有机磷农药成分方面无统计学差异（P＞0.05）。A组中毒患者入院时、48小时、72小时和144小时的D - LA浓度分布分别为（66±19）μg/L、（68±21）μg/L、（66±19）μg/L、（63±17）μg/L，而B组分别为（62±15）μg/L、（58±17）μg/L、（58±16）μg/L、（67±9）μg/L。两组D - LA浓度与健康人[（67±17）μg/L]相比无统计学差异（P＞0.05）。A组中毒患者入院时、48小时、72小时和144小时的DAO浓度分布分别为（2.1±0.6）μg/ml、（2.1±0.5）μg/ml、（2.2±0.4）μg/ml、（2.2±0.5）μg/ml，而B组分别为（2.1±0.5）μg/ml、（2.1±0.5）μg/ml、（2.2±0.5）μg/ml、（2.1±0.4）μg/ml。两组中毒早期的DAO浓度均高于健康人（0.1±0.0μg/ml）（P＜0.05）。A组和B组在不同时间点的DAO浓度无统计学差异（P＞0.05）。A组48小时和72小时的APACHE - Ⅱ评分（12.2 + 1.7，5.5 + 2.1）明显低于B组（14.1 + 2.4，8.2 + 2.6）（P＜0.05）。不同时间点的D - LA、DAO浓度与APACHE - Ⅱ评分无相关性（P＞0.05）。D - LA（r，P）在入院时为（ - 0.17，0.24），48小时为（0.04，0.79），72小时为（0.32，0.06），144小时为（0.29，0.07）；DAO（r，P）在入院时为（ - 0.12，0.43），48小时为（0.02，0.92），72小时为（0.03，0.85），144小时为（0.03，0.82）。ASOPP患者早期（144小时）肠道黏膜可能有明显损伤，但肠道通透性正常。早期肠内营养治疗可促进患者康复，但与肠道屏障功能改善的相关性较低。
