Role Of Intestinal Fatty Acid Binding Protein In Early Diagnosis Of Small Intestinal Rupture Caused By Closed Abdominal Injuries

Background With the development of the present contract mining and transportation industry,falling accident, traffic accidents have become more common, because of the small intestine occupy large abdominal space, damage probability is larger, more abdominal closed injury were often accompanied by small intestine contusion or intestinal rupture. Caused the rupture of small intestine external complex, impact, blow, extrusion and other direct violence,resulting in part of the intestine is affected by the direct damage and rupture; also falls, all of a sudden force or fast motion suddenly suspend indirect violence, because the force transduction or intestinal pressure suddenly leapt more than the tolerance of the intestinal wall and rupture; Can also be a lateral pushing shear stress on intestinal rupture, a few in pathological conditions such as the presence of abdominal viscera tissue adhesion, external force in the abdomen, limited range of motion of the bowel is involved, more easy to cause the damage of intestinal perforation. Rupture of small intestine is emergency surgery is a very common acute abdomen. The occurrence rate to occupy a large proportion of the whole abdomen injury, at present abdominal closed injury diagnosis of small intestinal rupture caused by is to existing conventional diagnostic methods based, treats the clinical signs of development to a certain extent, abdominal signs, imaging and biochemical abnormalities,even in the laparotomy diagnosed. Existing diagnostic methods include: asked in detail about the history of injury, including the injured parts, violent nature, size, and direction of, and after injury of the development process; careful investigation, on abdominal signs such as tenderness place, scope, shifting dullness, changes of the liver dullness, bowel sound changes shall be checked one by one, not clear at the time of diagnosis should be repeated examination,pay attention to the dynamic changes; Abdominal puncture, the method is an important means of early diagnosis, correct abdominal puncture and repeated, multiple puncture is the key to improve the positive rate of puncture. The puncture is negative can be repeated and multiple sites of puncture. Highly suspected visceral injury, by peritoneal lavage; abdominal X-ray examination, once found subphrenic free gas. The diagnosis was established. With abdominal open injury more intuitive and relatively easy to make a diagnosis and give treatment, but patients with closed abdominal injury, injury of small intestine perforation generally were smaller than the former, and not with the liver, spleen, pancreas and other parenchymatous organs rupture, early peritoneal stimulation syndrome is not clear, no typical radiographic inspection, the particularity and occult disease is easy to delay the diagnosis and treatment,often secondary peritonitis, sepsis and other complications and even result in the deterioration of the general situation. Intestinal infection plays an important role in the occurrence and development of sepsis. Therefore, in addition to the existing conventional treatment methods,it is necessary to explore more new diagnostic indicators to assist clinicians in the early diagnosis and treatment of small intestinal rupture. According to the domestic and foreign relevant literature was informed that the fatty acid binding protein(fatty acid binding protein,FABP) is a family of low molecular type protein and intestinal fatty acid binding protein(intestinal fatty acid binding protein, IFABP) is one of the members, located mainly in the small intestine mucosal microvilli tip, a group exists in cells in the fluid of a low molecular weight protein, the existence of a large number of in the epithelial cells of intestinal mucosa layer, accounting for 2-3% of the intestinal mucosal protein, in the intestinal mucosa oflong-chain fatty acid uptake, transport and metabolism regulation play an important role.Under normal circumstances, peripheral venous blood in undetectable IPABP, had small intestine mucous membrane rupture, the earliest occurrence of physiological and pathological change is microvillus tip, maintain the stability of the tip of the villi is broken and oxygen partial pressure decreased, resulting in necrosis of the intestinal villus tip cells and increased permeability of intestinal epithelial cells, the IPABP through the portal vein and celiac tube released into the blood. Intestinal fatty acid binding protein may be an early serological marker for intestinal mucosal injury. IFABP does not exist in the peripheral blood in normal circumstances, it is released into the blood and can be detected only when the small intestine rupture occurs. This change provides the possibility to become a marker of small intestinal rupture. The results showed that IFABP has a unique advantage in the diagnosis of intestinal rupture:(1) IPABP has better organ specificity, only in the intestinal tract. Also has specific antigenic determinants can be produced by immunological methods and other organizations of fatty acid binding proteins indistinguishable;(2) IFABP is a group exists in cells in the fluid of a low molecular weight protein, was mainly located in the small intestinal mucosa layer of the intestinal epithelial cells in liquid, of intestinal rupture caused by damage to the sensitive,in the event of small intestine rupture easily released into the blood, serum IFABP levels early in the course of disease were significantly elevated in good sensitivity;(3) IFABP accounted for 1% to 2% of cytosol protein, content is relatively rich and relatively small molecular weight of IFABP laboratory by enzyme linked immunosorbent assay for the direct detection of;(4) thermal instability exists in most of the serum enzyme, is heat labile enzyme, easy deactivation and affect the measurement accuracy, so determination need keep the activity of the enzyme, serum IFABP even at room temperature, keep stable for 24 h, 95% of the total activity, easy detection. Animal experimental results showed that the small intestine injury,serum and urine IFABP levels were significantly higher. The research results show that intestinal rupture patients at the time of admission, admission, 3 h after serum IFABP levels were significantly higher than those of the unruptured group, indicating that the abdominal closed injury in IFABP can be as small intestine rupture indicator for early diagnosis of.Objective Whereas IFABP in normal peripheral blood does not exist, only in the event of rupture of small intestine when released into the blood, and can be detected, the tissue content and molecular weight is small and easy to detect, high sensitivity and biochemical characteristics and the application in disease diagnosis provides the possibility. In addition, in recent years, domestic and foreign scholars have adopted the change of IFABP concentration in peripheral blood of patients with small intestinal rupture in recent years. The aim of this study was to explore the peripheral blood IFABP concentration in acute intestinal rupture before and after the changes, analysis its in acute traumatic intestinal rupture early diagnosis application value. According to the test data and statistical methods were applied to explore the concentration changes of peripheral blood in to verify whether it can be a rupture of small intestine of early serological marker for the diagnosis. Whether it can help the clinical diagnosis by reference to the changes, so that the subject research is particularly meaningful.Methods Due to the small intestine rupture caused by closed abdominal injury, the early stage of the disease is relatively hidden, which is the purpose of this study is to explore the diagnostic value of intestinal fatty acid binding protein in the diagnosis of small intestinal rupture. To observe the changes of intestinal fatty acid binding protein in early peripheralblood of small intestine rupture caused by closed abdominal injury, This experiment followed the December 2014 and 2015 August because of abdominal injury to surgical treatment in emergency department of our hospital, physician admissions highly suspected patients with rupture of small intestine, a total of 36. In such patients admitted to hospital, clinicians usually combined with medical history, through physical examination and modern examination technology, the patient’s condition for diagnosis. Commonly used imaging examination,including X-ray, B ultrasound, CT, etc.. In according to the existing in the conventional method of diagnosis and treatment at the same time were collected on admission and after admission 1 hour and was admitted to hospital after 3 hours three time points in peripheral venous blood, according to the final results of the diagnosis and treatment of existing in the conventional method of diagnosis and treatment, according to the small intestine rupture points for intestinal rupture group(n=12) and non intestinal rupture group(n=24). ELISA method was used to detect the blood concentration of IFABP, respectively. The comparison between the two groups of three time points difference.Results The IFABP concentration in the intestinal rupture group on admission(134.41 ± 53.34μg/L), 1(174.68 ± 69.06 μg/L) and 3(186.65 ± 90.08 μg/L) hours after admission was significantly higher than that in the non-intestinal rupture group(91.44 ± 40.37 μg/L、98.35 ±44.48 μg/L、104.51 ± 40.08 μg/L)(P<0.05).Conclusion Serum concentrations of IFABP can be used to the early diagnosis of small intestinal rupture caused by closed abdominal injuries.