| Objective:1.This study was designed to explore the association betweenthe intestinal mucosal barrier function and the severity of AP by testing theserum D-lactic acid concentration continually and APACHE-Ⅱassessmentin AP patients.2.to study the function of TNF-alpha,ITF and MFG-E8expression levels in and their relation with the intestinal mucosal injury andrepair in AP patients,through continual testing of these factors in theperipheral blood.Methods: Forty-five AP patients with abdominal pain admitted to theaffiliated hospital of Chuanbei Medical college in24hours were randomlyrecruited.All participants were with out Gastrointestinal disease,diabetes,cancer, mental illness and autoimmune diseases.According to the illnessseverity, patients were assign to group SAP(twenty-five cases) and groupMAP(twenty cases).Control group were health volunteers. The fastingvenous blood of the AP group and the control group was collected at the firstday, third and seventh days after admission. The content of the serum D-lacticacid, TNF-alpha, ITF and MFG-E8was detected by enzyme linkedimmunosorbent assay(ELISA). APACHE-Ⅱ assessment was performed atthe day of blood sampling and their clinical special information were noteddown in AP group. A database formed by these cytokines concentrations wasbuilt for statistical analysis with other clinical information. Results:1The first day after admission: The serum D-lactate acid and TNF-αlevels of SAP and MAP groups were significantly higher than that of thecontrol group (P <0.05);but the serum ITF and MGF-E8concentrations ofgroup SAP and MAP was significantly lower than did the control group(P<0.05).2The third day after admission: compared with the levels at the first day,the serum D-lactate acid and TNF-α levels of the SAP group and MAP groupdecreased significantly (P <0.05), but still higher than that in the controlgroup (P <0.05); the serum ITF concentration increased in both SAP andMAP groups(P <0.05) and higher than did the control group (P <0.05).SAP group showed a significant(P<0.05) increase in MGF-E8level, but didnot the MAP group(P＞0.05).Both the MGF-E8levels in SAP group andMAP group were lower than did the control group(P＜0.05).3The seventh day after admission: compared with the levels at the thirdday, the serum D-lactate acid,TNF-α and ITF levels of the SAP group andMAP group declined（P＜0.05）, The serum D-lactate acid,TNF-α and ITFconcentration of SAP group was still significantly higher that of the controlgroup (P <0.05). No significant difference in the serum D-lactateacid,TNF-α and ITF concentration between the MAP group and the controlgroup was found(P＞0.05). Serum MFG-E8concentration of the SAP groupand MAP group kept a continuous upward trend and SAP group had a mildincrese which was not statistically significant (P＞0.05), but MAP group hada significant increase (P<0.05),compared with the level at the third day afteradmission. And the MFG-E8of the both group increased siginificantlycompared with the level at the first day （P＜0.05）. MFG-E8level of SAPgroup was significantly lower than did the control group (P<0.05).And MFG-E8level of MAP group was near to normal level and no significantdifferences was found compared with the control group(P＞0.05).4There were significant differences in APACHE-Ⅱ score between SAPand MAP groups at the first day,third day and seventh day ofadmission(P<0.05).5Spearman correlation analysis revealed that serum D-lactic acidcontent highly and positively correlated with APACHE-Ⅱscores, and thecorrelation coefficient was0.876; serum TNF-α content also highly andpositively correlated with serum D-lactic acid content, and the correlationcoefficient was0.908; serum TNF-α content highly and positively correlatedwith APACHE-Ⅱ and the correlation coefficient was0.877;but serumMFG-E8content was negativly correlated with serum D-lactic acid contentand the correlation coefficient was-0.687.Conclusion:1The change of serum D-lactic acid content can reflect the severity ofthe intestinal mucosal barrier injury in AP patients. It can be used as aindicators of both the disease severity and treatment effect in AP patients.2TNF-α may damage the intestinal mucosal barrier in the early onset ofAP, and increase the permeability of the intestinal mucosa. It could promotethe occurrence and development of AP, especially the SAP. In addition, serumTNF-α is expected to become one of the index of the continual observationsfor AP. 3The decrease in ITF, MFG-E8expression may be an importantmechanism of intestinal barrier injury,which suggest increasing the ITF,MFG-E8express might become a new way to treat intestinal mucosal barrierinjury in AP. |
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