Olivero Chiara, Carbone Federico, Liberale Luca, Montecucco Fabrizio
First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto XV, 16132, Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy.
Intern Emerg Med. 2025 Mar;20(2):369-379. doi: 10.1007/s11739-024-03808-z. Epub 2024 Nov 8.
Intestinal ischemia (IIs) is a significant gastrointestinal condition characterized by reduced blood flow to the bowel, leading to inflammation and injury. Early diagnosis and management are crucial for preventing severe complications. Under this point of view, circulating biomarkers can enhance patient stratification and guide therapeutic decisions. Fatty acid-binding proteins (FABPs), specifically I-FABP and L-FABP, are small cytosolic proteins released upon enterocyte membrane integrity loss, with elevated plasma levels indicating early intestinal ischemia. Stromal Cell-Derived Factor-1 (SDF-1) regulates stem cell function and shows significantly higher levels in patients with IIs and cardiovascular disease compared to controls. D-Lactate, a bacterial fermentation byproduct, is another significant marker, with higher serum levels observed in intestinal ischemia cases. Alpha-glutathione S-transferase combats intracellular oxidative stress, with significantly elevated levels in acute mesenteric ischemia patients. Additionally, SM22, a small smooth muscle protein, shows higher plasma levels in patients with transmural ischemia compared to those with mucosal ischemic lesions and healthy controls. These biomarkers are promising for their roles in early detection and differentiation of IIs from other gastrointestinal conditions. Therapeutic strategies, including anti-inflammatory therapies, have shown efficacy in managing IIs symptoms and preventing recurrence. This review aims to inform clinicians and researchers about the current advancements in biomarker research and therapeutic approaches for IIs, emphasizing the importance of integrating these biomarkers and treatments into clinical practice to improve the management and prognosis of the disease.
肠缺血（IIs）是一种严重的胃肠道疾病，其特征是肠道血流减少，导致炎症和损伤。早期诊断和治疗对于预防严重并发症至关重要。从这一角度来看，循环生物标志物可以改善患者分层并指导治疗决策。脂肪酸结合蛋白（FABPs），特别是I-FABP和L-FABP，是在肠细胞膜完整性丧失时释放的小细胞质蛋白，血浆水平升高表明早期肠缺血。基质细胞衍生因子-1（SDF-1）调节干细胞功能，与对照组相比，在IIs患者和心血管疾病患者中其水平显著更高。D-乳酸是一种细菌发酵副产物，是另一个重要标志物，在肠缺血病例中观察到血清水平更高。α-谷胱甘肽S-转移酶对抗细胞内氧化应激，在急性肠系膜缺血患者中水平显著升高。此外，SM22是一种小的平滑肌蛋白，与黏膜缺血性病变患者和健康对照相比，透壁缺血患者的血浆水平更高。这些生物标志物因其在IIs早期检测以及与其他胃肠道疾病鉴别方面的作用而颇具前景。包括抗炎治疗在内的治疗策略已显示出在管理IIs症状和预防复发方面的疗效。本综述旨在向临床医生和研究人员介绍IIs生物标志物研究和治疗方法的当前进展，强调将这些生物标志物和治疗方法整合到临床实践中以改善疾病管理和预后的重要性。
