Murray M J, Gonze M D, Nowak L R, Cobb C F
Department of Surgery, Medical College of Pennsylvania, Pittsburgh.
Am J Surg. 1994 Jun;167(6):575-8. doi: 10.1016/0002-9610(94)90101-5.
No serum marker has consistently proved helpful in diagnosing early acute mesenteric ischemia. D(-)-lactate is a product of bacterial metabolism and was found to be elevated in peripheral blood in a rat model of intestinal ischemia. We conducted a prospective study to evaluate preoperative D(-)-lactate levels in 31 patients undergoing laparotomy for acute abdominal emergencies, including suspected acute mesenteric ischemia. The serum was deproteinated and D(-)-lactate concentration was determined by a spectrophotometric assay. A control group was composed of patients with a benign abdominal examination who were operated on for central venous line placement. We found significant elevations in D(-)-lactate levels in patients with mesenteric ischemia compared with controls (P < 0.00005), as well as in patients with other forms of abdominal catastrophes (P < 0.00005) and with bowel obstruction (P < 0.0005). Sensitivity and specificity were 90% and 87%, respectively. The negative predictive value was 96%, and the positive predictive value was 70%. We have found that D(-)-lactate serum levels can aid in diagnosing acute mesenteric ischemia.
尚无血清标志物被证实始终有助于早期急性肠系膜缺血的诊断。D(-)-乳酸是细菌代谢产物，在肠道缺血大鼠模型中发现其外周血水平升高。我们进行了一项前瞻性研究，以评估31例因急性腹部急症（包括疑似急性肠系膜缺血）接受剖腹手术患者的术前D(-)-乳酸水平。血清进行去蛋白处理，采用分光光度法测定D(-)-乳酸浓度。对照组由因放置中心静脉导管而接受手术的腹部检查正常的患者组成。我们发现，与对照组相比，肠系膜缺血患者的D(-)-乳酸水平显著升高（P < 0.00005），其他形式腹部灾难患者（P < 0.00005）和肠梗阻患者（P < 0.0005）也是如此。敏感性和特异性分别为90%和87%。阴性预测值为96%，阳性预测值为70%。我们发现，血清D(-)-乳酸水平有助于诊断急性肠系膜缺血。
