Günel E, Cağlayan O, Cağlayan F
Departments of Pediatric Surgery, and Biochemistry, Medical School of Selçuk University, Konya, Turkey.
Pediatr Surg Int. 1998 Nov;14(1-2):59-61. doi: 10.1007/s003830050436.
Currently, no serum marker has proved helpful in diagnosing intestinal ischemia and reperfusion (I/R) injury. An experimental study was conducted to determine the value of serum D-lactate in detecting intestinal I/R injury. Thirty New Zealand White rabbits were divided into three groups of 10 animals each: sham-operation controls (S); I/R; and I/R plus mannitol treatment (M). Serum samples were obtained before operation (T0), at the end of the ischemic period (T1), after the first 30 min of reperfusion (T2), and at the end of the reperfusion period (T3). In Group S, mean D-lactate levels for T0, T1, and T2 were 0 microgram/dl, while T3 was 5. 8 +/- 4.7 micrograms/dl. Before the operation (T0), serum mean D-lactate levels were 0 microgram/dl in all groups (S, I/R, M). Levels increased after 1 h of ischemia (T1) in groups I/R (83.5 +/- 25.6 micrograms/dl) and M (89.8 +/- 19.9 micrograms/dl), but not in group S (0 microgram/dl). The mean T2 level in group I/R (231.6 +/- 78.6 micrograms/dl) was statistically higher than in group M (140.1 +/- 53.5 micrograms/dl) (P = 0.007). At the end of the reperfusion period, the mean T3 level in group I/R (698.4 +/- 360.4 micrograms/dl) was significantly higher than in group M (158.7 +/- 61.4 micrograms/dl) (P = 0.000). In group I/R, mean D-lactate levels changed significantly at each time point (T1 vs T2, P = 0.001; T2 vs T3, P = 0.004). However, in group M the increase from T1 to T2 was significant (P = 0.012), but that from T2 to T3 was not (P = 0.293). As a result, the mean T3 level was significantly higher than the T2 level in group I/R (P = 0.004), but not in group M. This study confirmed a significance rise in D-lactate levels in animals with I/R injury compared to sham-operated and I/R injury plus M treatment. We suggest that serum D-lactate levels could be a useful marker of intestinal I/R injury before laparatomy.
目前，尚无血清标志物被证明对诊断肠道缺血再灌注（I/R）损伤有帮助。进行了一项实验研究以确定血清D-乳酸在检测肠道I/R损伤中的价值。30只新西兰白兔被分为三组，每组10只动物：假手术对照组（S）；I/R组；以及I/R加甘露醇治疗组（M）。在手术前（T0）、缺血期末（T1）、再灌注最初30分钟后（T2）以及再灌注期末（T3）采集血清样本。在S组中，T0、T1和T2时D-乳酸的平均水平为0微克/分升，而T3时为5.8±4.7微克/分升。在手术前（T0），所有组（S组、I/R组、M组）血清D-乳酸平均水平均为0微克/分升。I/R组（83.5±25.6微克/分升）和M组（89.8±19.9微克/分升）在缺血1小时后（T1）水平升高，而S组（0微克/分升）未升高。I/R组T2时的平均水平（231.6±78.6微克/分升）在统计学上高于M组（140.1±53.5微克/分升）（P = 0.007）。在再灌注期末，I/R组T3时的平均水平（698.4±360.4微克/分升）显著高于M组（158.7±61.4微克/分升）（P = 0.000）。在I/R组中，每个时间点D-乳酸平均水平变化显著（T1与T2相比，P = 0.001；T2与T3相比，P = 0.004）。然而，在M组中，从T1到T2升高显著（P = 0.012）但从T2到T3升高不显著（P = 0.293）。结果，I/R组T3时的平均水平显著高于T2时（P = 0.004），而M组并非如此。本研究证实与假手术组以及I/R损伤加M治疗组相比，I/R损伤动物的D-乳酸水平显著升高。我们认为血清D-乳酸水平可能是剖腹手术前肠道I/R损伤的有用标志物。
