The Comparison Research Of Urine Lactulose/mannitol And Polyethylene Glycol 600 Test On Evaluating Intestinal Permeability

Background and AimsIntestinal barrier failure(IBF), which is able to cause intestine-originated sepsis, is a common secondary syndrome. It is believed to be associated with pancreatis, liver cirrhosis, advanced stage tumor and leukemia and so on. IBF is mainly accompanied by the increase of the intestinal permeability and the imbalance of the intestinal microflora. Recently there are three main molecular probes used to test intestinal permeability, including sugar probe, isotope probe and polyethylene glycol (PEG) probe, of which lactulose and mannitol double-sugar probe is frequently used. Although procedures are much complicated, chromatography are usually applied in lactulose/ mannitol ratio (L/M) test. In our article, we compared the values of two different test approaches (the L/M test detected by chromatography and low molecular PEG detected by photometry) in Fe(SCN)3-CHC13 system on evaluating intestinal permeability in several diseases. We wondered whether urine low molecular PEG test could be a more convenient and nearly precise method for clinical usability. MethodsPatients were enrolled in the study including digestive system tumor, cirrhosis, IBD. Urine collection was used to test lactulose/mannitol radio by gas chromatography to assess intestinal permeability after oral administration of the double-sugar probe. After administration of PEG600 probe in another day, urine collection was used to analyse the content of PEG600 probe by Fe(SCN)3-CHC13 system by photometry. The comparisons of patients and controls on urine L/M ratio test and urine content of PEG600 test were respectively analyzed in order to discuss whether the urine PEG600 probe test might be used in scientific research and clinical analysis on assessing intestinal permeability.Results1. The urine lactulose/mannitol ratios in patients (0.06842±0.02275) were significantly higher than those of volunteers (0.03043±0.00663)(t=8.171,P<0.05). The urine PEG600 contents in patients (801.2898±236.6503) were statistically higher than those of voluteers (581.2222±85.7258)( t= 4.492,P<0.05).2. There was no significance between PEG600 probe by photometry and double sugar probe by chromatography, which concluded that PEG600 probe was of diagnostic value (P=0.118>0.05) .No significance between two methods used in digestive system tumor, cirrhosis, IBD (P>0.05). High goodness of fit in IBD (P=0.25>0.05, Kappa = 0.519) and digestive system tumor (P=0.687>0.05, Kappa = 0.43) but low in cirrhosis (P=0.232>0.05, Kappa = 0.26) .3. The side effects such as diarrhea and stomachache caused by PEG600 probe were obviously slighter than those caused by sugar probe in digestive system tumor, cirrhosis and IBD (P<0.05). Conclusion1. Urine dual-sugar probe is actually an accurate permeability index. The shortages of this method are as follows: costly sugar probe, great side effects, complicated procedure, toxin of derivatizaed solution and relatively long detection time.The photometry test is of much less side effects and has some diagnostic values.2. The diagnostic values of PEG600 used to test intestinal permeability in patients with IBD and digestive system tumor is higher than those in patients with cirrhosis.