The Significance Of Changes In Diamine Oxidase And D-Lactate Activity Reflecting Intestinal Injury After Intestinal Obstruction In Infant

Objective: To investigate the changes in diamine oxidase (DAO) andD-lactate activity,C-reactive protein(CRP),Creatine Kinase's Isozyme(CK-MB),white cell(WBC) after intestinal obstruction in infant andevaluate whether the significance of these changes can reflectintestinal injury。By doing these,we want to construct a systemic andideal makers for estimating intestinal injury with intestinalobstruction ,which have clinical guiding significance for selectingright treatment to intestinal obstruction.Methods:From march 2004 to may 2004,a preoperative blood was obtainedfrom 40 intestinal obstruction for the determinent of CRP,CK-MB,WBC 。9 cases of them were acute intussusception,23 cases wereincarerated henia ,2 cases were obstruction from bezoar,6 cases wereacute adhesive obstruction,(2month-2year,average age 11month).Frommay 2004 to november 2004, sample before operation and the thirdday blood sample also be required from 50 patients undergoing surgeryfor intestinal obstruction. sample also be required in 16 healthyinfant.they all be save under 700C.32 cases of them were acuteintussusception,11 cases were incarerated henia ,2 cases wereovolvulus,1 case was mesenteric hernia,2 cases were acute adhesive obstruction,2 cases were intestinal obstruction for stenosis ofileu(2month-2year,average age 12month).diamine oxidase and D-lactatein the serum were determined by a spectrophotometric assay. we sortpatients into low-grade and middle-most grade intestinal ischemiaby clinical situation and morpha and(or) pathology of intestine. Results:1.40intestinal obstruction CRP significantly increasedand correlated with clinical situation .CK-MB,WBC also increasedbut poor correlation with clinical situation .2.Plasma DAO and D-lactate activity significantly increased in 50patients undergoing surgery for intestinal obstruction.there wassignificant difference between middle-most and low-grade gradeintestinal ischemia.After operation,plasma DAO and D-lactate activitydecreased.3.when predict low grade intestinal ischemia by D-lactate >6 ug/ml,sensitivity and specificity were 96%and84.6%。when predict middle-mostgrade intestinal ischemia by D-lactate >15 ug/ml ,sensitivity andspecificity were 97.3% and69%。when predict low grade intestinalischemia by DAO>20 mg/ml,sensitivity and specificity were 96%and84.6%。when predict middle-most grade intestinal ischemia by diamine oxidase>30 mg/ml,sensitivity and specificity were 94.7%and67%。Conclusions:intestinal barrier function is damaged with the prolongintestinal ischemia.CRP can correlate with clinical situation but nospecificity;the change of WBC and CK-MB seems to have little sensitity with the degree of intestinal injury.plasma DAO and D-lactate activity may be a ideal marker of estimating intestinal injury after intestinal obstruction.