Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Vasc Health Risk Manag. 2022 Jul 21;18:567-574. doi: 10.2147/VHRM.S365625. eCollection 2022.
Chronic mesenteric ischemia (CMI) due to either atherosclerosis of the mesenteric arteries or median arcuate ligament syndrome (MALS) is an underdiagnosed entity. The etiology of MALS and its existence have been debated and questioned. We aimed to identify plasma biomarkers indicating mesenteric ischemia in patients with CMI and MALS.
Plasma α-glutathione S-transferase (α-GST), intestinal fatty acid-binding protein (I-FABP), citrulline, and ischemia modified albumin (IMA) were analyzed in fifty-eight patients with CMI (Group A, n=44) and MALS (Group B, n=14) before and after revascularization. The plasma levels of these potential biomarkers were compared with those of healthy individuals (Group C, n=16). Group comparison was performed with the Mann-Whitney -test. Cross-tabulation and its derivatives were obtained. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated.
Plasma levels of α-GST were significantly raised in the patients with CMI (7.8 ng/mL, p<0.001) and MALS (8.4 ng/mL, p<0.001), as compared with the control Group C (3.3 ng/mL). The threshold for normal median plasma α-GST levels of 4 ng/mL yielded a sensitivity of 93% and 86%, specificity of 86% and 88%, respectively, for the diagnosis of CMI due to atherosclerosis and MALS. AUC of ROC curves was 0.96 (p<0.0001) for CMI and 0.85 (p<0.002) for MALS. The patient groups did not differ from the healthy controls in any other biomarkers.
Plasma α-GST levels are elevated in CMI and MALS patients. Elevated plasma levels of α-GST suggest ischemia as the etiology of MALS.
肠系膜动脉粥样硬化或中弓状韧带综合征（MALS）引起的慢性肠系膜缺血（CMI）是一种诊断不足的疾病。MALS 的病因及其存在一直存在争议和质疑。我们旨在确定提示 CMI 和 MALS 患者肠系膜缺血的血浆生物标志物。
在血管重建术前和术后，分析了 58 例 CMI 患者（A 组，n=44）和 MALS 患者（B 组，n=14）的血浆α-谷胱甘肽 S-转移酶（α-GST）、肠脂肪酸结合蛋白（I-FABP）、瓜氨酸和缺血修饰白蛋白（IMA）。将这些潜在生物标志物的血浆水平与健康个体（C 组，n=16）进行比较。使用 Mann-Whitney U 检验进行组间比较。获得交叉表及其衍生表。计算接收者操作特征（ROC）曲线和曲线下面积（AUC）。
与 C 组相比，CMI 患者（7.8ng/mL，p<0.001）和 MALS 患者（8.4ng/mL，p<0.001）的血浆α-GST 水平显著升高。正常中位数血浆α-GST 水平为 4ng/mL 的阈值对动脉粥样硬化性 CMI 和 MALS 的诊断具有 93%和 86%的敏感性、86%和 88%的特异性。ROC 曲线的 AUC 分别为 0.96（p<0.0001）和 0.85（p<0.002）。在任何其他生物标志物方面，患者组与健康对照组均无差异。
CMI 和 MALS 患者的血浆α-GST 水平升高。升高的血浆α-GST 水平提示 MALS 的病因是缺血。
