Values of Histidine Decarboxylase, D-lactate, and Alpha-Glutathione S-Transferase for Diagnosing Intestinal Mucosal Injury in Patients with Intestinal Obstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jianjun ,  QIN Huanlong.

Department of General Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China;

Corresponding author：

QIN Huanlong., Email: hlqin@sjtu.edu.cn

Keywords：

Histidine decarboxylase; D-lactate; Alpha-glutathione S-transferase; Intestinal obstruction; Intestinal mucosal injury

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ObjectiveTo investigate the clinical values of serum histidine decarboxylase (HDC), D-lactate, and alpha-glutathione S-transferase (α-GST) for diagnosing intestinal mucosal injury of patients with intestinal obstruction. MethodsThe expression levels of serum HDC, D-lactate, and α-GST in 28 patients with strangulated intestinal obstruction, 19 patients with simple intestinal obstruction, 17 patients with acute simple appendicitis, and 20 healthy volunteers were determined by enzyme linked immunosorbent assay (ELISA) before the treatment, and then the area under receiver operating characteristic curve (AUC) of these diagnostic indices were compared. In addition, the occurrence rates of systemic inflammatory response syndrome (SIRS) and infectious complications (abdominal cavity infection and pulmonary infection) were closely observed. The relevances of SIRS and infectious complications and the expression levels of these three diagnostic indices were analyzed. ResultsThe expression levels of serum HDC, D-lactate, and α-GST of the patients with strangulated intestinal obstruction were the highest among all the patients (P lt;0.01), and the expression levels of these three indices in the patients with simple intestinal obstruction were higher than those of the patients with acute simple appendicitis (P lt;0.05). The AUC of HDC (0.913) was larger than that of D-lactate (0.872) and α-GST (0.836) (P=0.000, P=0.000, respectively). When the cut off value of HDC was 31.00 μg/L, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5%, 94.6%, 25.5%, and 5.4%, respectively, which were all better than those of D-lactate and αGST. The occurrence rates of SIRS and abdominal cavity infection of the patients with strangulated intestinal obstruction were significantly higher than those of patients with simple intestinal obstruction (P=0.046) and acute simple appendicitis (P=0.027); while there was not significantly different of pulmonary infection among all the patients (P=0.728). The expression level of serum HDC in patients with strangulated intestinal obstruction suffered from SIRS (P=0.000) or abdominal cavity infection (P=0.002) was significantly higher than that of not-suffered from SIRS or uninfected patients. Meanwhile, the expression levels of serum D-lactate and α-GST in the patients with strangulated intestinal obstruction suffered from SIRS were higher than those of notsuffered from SIRS patients (P=0.032, P=0.021, respectively). The expression levels of HDC, D-lactate, and α-GST were significantly correlated with SIRS and abdominal cavity infection (P lt;0.05), among which the level of HDC and the incidence of SIRS had the highest correlation (r=0.608, P=0.001). ConclusionHDC may be a more effective index for diagnosing intestinal mucosal injury of patients with intestinal obstruction.

Citation： YANG Jianjun,QIN Huanlong.. Values of Histidine Decarboxylase, D-lactate, and Alpha-Glutathione S-Transferase for Diagnosing Intestinal Mucosal Injury in Patients with Intestinal Obstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1248-1253. doi: Copy

1.	Rahman SH, Ammori BJ, Holmfield J, et al. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis [J]. J Gastrointest Surg, 2003, 7(1): 2635.
2.	Zhang X, Chen L, Luo L, et al. Study of the protective effects of dexamethasone on ileum mucosa injury in rats with severe acute pancreatitis [J]. Pancreas, 2008, 37(3): e74e82.
3.	刘中辉, 杜艳平, 李初俊, 等. 生态免疫肠内营养对重症胰腺炎大鼠肠屏障功能和胰腺炎症的影响 [J]. 中华临床营养杂志, 2010, 18(2): 106110.
4.	de Haan JJ, Lubbers T, Derikx JP, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study [J]. Crit Care, 2009, 13(3): R86.
5.	Jin W, Wang HD, Hu ZG, et al. Transcription factor Nrf2 plays a pivotal role in protection against traumatic brain injuryinduced acute intestinal mucosal injury in mice [J]. J Surg Res, 2009, 157(2): 251260.
6.	Derikx JP, Matthijsen RA, de Brune AP, et al. Rapid reversal of human intestinal ischemiareperfusion induced damage by shedding of injured enterocytes and reepithelialisation [J]. PLoS One, 2008, 3(10): e3428.
7.	陈雪峰, 何桂珍, 董良广, 等. 大鼠肠道缺血再灌注损伤时高迁移率族蛋白1变化及淋巴引流对肠屏障的保护作用 [J]. 中华临床营养杂志, 2009, 17(2): 9194.
8.	Guan Y, Worrell RT, Pritts TA, et al. Intestinal ischemiareperfusion injury: reversible and irreversible damage imaged in vivo [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(1): G187G196.
9.	Gurleyik G, Ozturk E, Gurleyik E, et al. Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction [J]. J Invest Surg, 2003, 16(5): 283288.
10.	Chang T, Lu R, Tsai L. Glutamine ameliorates mechanical obstructioninduced intestinal injury [J]. J Surg Res, 2001, 95(2): 133140.
11.	陈国卫, 刘玉村. 肠梗阻的手术适应证和剖腹探查 [J]. 中国实用外科杂志, 2003, 23(7): 398400.
12.	Grotz MR, Deitch EA, Ding J, et al. Intestinal cytokine response after gut ischemia: role of gut barrier failure [J]. Ann Surg, 1999, 229(4): 478486.
13.	Faries PL, Simon RJ, Martella AT, et al. Intestinal permeability correlates with severity of injury in trauma patients [J]. J Trauma, 1998, 44(6): 10311035.
14.	Bone RC, Balk RA, Cerra FB, et al. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis [J]. Crit Care Med, 1992, 20(6): 864874.
15.	中华医学会消化病学分会. 肠屏障功能障碍临床诊治建议 [J]. 中华消化杂志, 2006, 26(9): 620.
16.	Murray MJ, Gonze MD, Nowak LR, et al. Serum D()lactate levels as an aid to diagnosing acute intestinal ischemia [J]. Am J Surg, 1994, 167(6): 575578.
17.	Assadian A, Assadian O, Senekowitsch C, et al. Plasma Dlactate as a potential early marker for colon ischaemia after open aortic reconstruction [J]. Eur J Vasc Endovasc Surg, 2006, 31(5): 470474.
18.	Delaney CP, O’neill S, Manning F, et al. Plasma concentrations of glutathione Stransferase isoenzyme are raised in patients with intestinal ischaemia [J]. Br J Surg, 1999, 86(10): 13491353.
19.	Handley SA, Dube PH, Miller VL. Histamine signaling through the H2 receptor in the peyer’s patch is important for controlling yersinia enterocolitica infection [J]. Proc Natl Acad Sci USA, 2006, 103(24): 92689273.
20.	Kahlson G, Rosengren E. New approaches to the physiology of histamine [J]. Physiol Rev, 1968, 48(1): 155196.
21.	Fujimoto K, Imamura I, Granger DN, et al. Histamine and histidine decarboxylase are correlated with mucosal repair in rat small intestine after ischemiareperfusion [J]. J Clin Invest, 1992, 89(1): 126133.
22.	Mei Q, Sundler F. Local downregulation of enterochromaffinlike cell histamine formation in ulcer healing: a study in rats [J]. Digestion, 1999, 60(3): 227237.
23.	Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve [J]. Am J Epidemiol, 2006, 163(7): 670675.

1. Rahman SH, Ammori BJ, Holmfield J, et al. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis [J]. J Gastrointest Surg, 2003, 7(1): 2635.
2. Zhang X, Chen L, Luo L, et al. Study of the protective effects of dexamethasone on ileum mucosa injury in rats with severe acute pancreatitis [J]. Pancreas, 2008, 37(3): e74e82.
3. 刘中辉, 杜艳平, 李初俊, 等. 生态免疫肠内营养对重症胰腺炎大鼠肠屏障功能和胰腺炎症的影响 [J]. 中华临床营养杂志, 2010, 18(2): 106110.
4. de Haan JJ, Lubbers T, Derikx JP, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study [J]. Crit Care, 2009, 13(3): R86.
5. Jin W, Wang HD, Hu ZG, et al. Transcription factor Nrf2 plays a pivotal role in protection against traumatic brain injuryinduced acute intestinal mucosal injury in mice [J]. J Surg Res, 2009, 157(2): 251260.
6. Derikx JP, Matthijsen RA, de Brune AP, et al. Rapid reversal of human intestinal ischemiareperfusion induced damage by shedding of injured enterocytes and reepithelialisation [J]. PLoS One, 2008, 3(10): e3428.
7. 陈雪峰, 何桂珍, 董良广, 等. 大鼠肠道缺血再灌注损伤时高迁移率族蛋白1变化及淋巴引流对肠屏障的保护作用 [J]. 中华临床营养杂志, 2009, 17(2): 9194.
8. Guan Y, Worrell RT, Pritts TA, et al. Intestinal ischemiareperfusion injury: reversible and irreversible damage imaged in vivo [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(1): G187G196.
9. Gurleyik G, Ozturk E, Gurleyik E, et al. Prostaglandins E1 and E2 analogues ameliorate mucosal injury secondary to distal colonic obstruction [J]. J Invest Surg, 2003, 16(5): 283288.
10. Chang T, Lu R, Tsai L. Glutamine ameliorates mechanical obstructioninduced intestinal injury [J]. J Surg Res, 2001, 95(2): 133140.
11. 陈国卫, 刘玉村. 肠梗阻的手术适应证和剖腹探查 [J]. 中国实用外科杂志, 2003, 23(7): 398400.
12. Grotz MR, Deitch EA, Ding J, et al. Intestinal cytokine response after gut ischemia: role of gut barrier failure [J]. Ann Surg, 1999, 229(4): 478486.
13. Faries PL, Simon RJ, Martella AT, et al. Intestinal permeability correlates with severity of injury in trauma patients [J]. J Trauma, 1998, 44(6): 10311035.
14. Bone RC, Balk RA, Cerra FB, et al. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis [J]. Crit Care Med, 1992, 20(6): 864874.
15. 中华医学会消化病学分会. 肠屏障功能障碍临床诊治建议 [J]. 中华消化杂志, 2006, 26(9): 620.
16. Murray MJ, Gonze MD, Nowak LR, et al. Serum D()lactate levels as an aid to diagnosing acute intestinal ischemia [J]. Am J Surg, 1994, 167(6): 575578.
17. Assadian A, Assadian O, Senekowitsch C, et al. Plasma Dlactate as a potential early marker for colon ischaemia after open aortic reconstruction [J]. Eur J Vasc Endovasc Surg, 2006, 31(5): 470474.
18. Delaney CP, O’neill S, Manning F, et al. Plasma concentrations of glutathione Stransferase isoenzyme are raised in patients with intestinal ischaemia [J]. Br J Surg, 1999, 86(10): 13491353.
19. Handley SA, Dube PH, Miller VL. Histamine signaling through the H2 receptor in the peyer’s patch is important for controlling yersinia enterocolitica infection [J]. Proc Natl Acad Sci USA, 2006, 103(24): 92689273.
20. Kahlson G, Rosengren E. New approaches to the physiology of histamine [J]. Physiol Rev, 1968, 48(1): 155196.
21. Fujimoto K, Imamura I, Granger DN, et al. Histamine and histidine decarboxylase are correlated with mucosal repair in rat small intestine after ischemiareperfusion [J]. J Clin Invest, 1992, 89(1): 126133.
22. Mei Q, Sundler F. Local downregulation of enterochromaffinlike cell histamine formation in ulcer healing: a study in rats [J]. Digestion, 1999, 60(3): 227237.
23. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve [J]. Am J Epidemiol, 2006, 163(7): 670675.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Values of Histidine Decarboxylase, D-lactate, and Alpha-Glutathione S-Transferase for Diagnosing Intestinal Mucosal Injury in Patients with Intestinal Obstruction

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