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 (Plt;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 (Plt;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 αGST. 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 notsuffered 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 (Plt;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.
ObjectiveTo investigate the application significance of serum histidine decarboxylase (HDC) and D-lactate for early-stage of strangulated intestinal obstruction in rats. MethodsThirty male Wistar rats were randomly divided into two groups:blank control group (n=10) and experimental group (n=20). Rats of experimental group were established to be strangulated intestinal obstruction model by ligating 4 cm-long ileum, and were divided into obstruction-1 hour group (n=10) and obstruction-3 hour group (n=10) according to the time of intestinal obstruction. Rats of blank control group only underwent sham operation. When intestinal obstruction models were built, the change of pathology in ileum tissue was observed by light microscope. The Park/Chiu scale was used to evaluate the severity of intestinal lesion. At the same time, blood was drawn from the heart to measure the concentration of serum HDC and D-lactate by ELISA method. Real time quantitative PCR was used to detect the expression of HDC mRNA in ileum tissues. ResultsThe median injury score of ileum tissues of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 (0-1), 2 (2-3), and 5 (4-5) respectively, and increased in blank control group, obstruction-1 hour group, and obstruction-3 hour group one by one (P<0.01). The median concentrations of serum HDC of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 10.5 pg/mL (4.60-17.18 pg/mL), 87.93 pg/mL (41.33-119.03 pg/mL), and 150.67 pg/mL (67.33-198.14 pg/mL) respectively, and increased in blank control group, obstruc-tion-1 hour group, and obstruction-3 hour group one by one (P<0.05). The median concentrations of serum D-lactate in rats of blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 ng/mL (0-3.90 ng/mL), 0 ng/mL (0-15.63 ng/mL), and 4.92 ng/mL (0-48.13 ng/mL) respectively, and there was no significant difference among the 3 groups (P>0.05). The median expression levels of HDC mRNA in ileum tissue of rats in obstruction-3 hour group was 7.81 (7.05-8.39), which was significantly higher than those of the obstruction-1 hour group[1.77 (1.74-1.94)] and blank control group[0.97 (0.88-1.15)], P<0.01, but there was no significant difference between obstruction-1 hour group and blank control group (P>0.05). ConclusionsConcentration of serum HDC can be used for early diagnosis of strangulated intestinal obstruction. Serum D-lactate has no significant change at early-stage of strangulated intestinal obstruction.
ObjectiveTo assess the predictive abilities of postoperative regional oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS) and lactate level for early postoperative outcome in children undergoing congenital heart disease surgery.MethodsA total of 73 children (43 males, 30 females, mean age of 91±18 days) undergoing cardiovascular surgery were enrolled from December 2016 to September 2017. The 73 children were divided into an early poor outcome group and a without poor outcome group. Binary logistic regression method was used to determine the independent factors of predicting early poor outcome. Receiver operating characteristic curve was used to identify the optimal cutoff values.ResultsThe early poor outcome rate was 47%. By regression analyses, nadir splanchnic rSO2 values, peak lactate level were 2 independent factors of predicting poor outcome. For nadir splanchnic rSO2 alone, the area under the ROC curve for poor outcome were 0.897. For peak lactate alone, the area under the ROC curve for poor outcome was 0.867. After combination of nadir splanchnic rSO2 and peak lactate, the area under the ROC curve for poor outcome increased to 0.944 (P<0.05).ConclusionCombining the parameter of nadir splanchnic rSO2 and peak lactate during the first postoperatively 24 hours yielded to a more accurate predictive ability for early outcome in children undergoing congenital cardiac surgery.
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.