[Intestinal mucosal barrier dysfunction after abdominal operation and its clinical significance].
OBJECTIVE
To investigate the plasma glutamine (Gln) level and relationships between the intestinal mucosal permeability and bacterial translocation and between bacterial translocation and systemic inflammatory response syndrome (SIRS) after abdominal operation.


METHODS
The peripheral blood was collected from 42 patients before and 2 and 7 days after elective abdominal operation. The plasma Gln concentration and lactulose/mannitol (L/M) ratio were measured and the whole blood bacterial DNA concentration was determined by polymerase chain reaction (PCR). The relationship between intestinal mucosal barrier dysfunction and the occurrence of postoperative SIRS was analyzed.


RESULTS
The plasma Gln level was significantly lowered (P<0.01) and L/M ratio increased (P<0.01) in these patients 2 and 7 days after the operation in comparison with the preoperative level. No bacterial DNA was detected before surgery, but PCR yielded positive results in 4 patients (9.5%, 4/42) at 2 days and in another patient at 7 days (2.4%, 1/42) after the operation. The 4 patients with positive PCR results 2 days after the operation showed significantly lower plasma Gln concentration (P<0.01) and higher L/M ratio (P<0.01) than those with negative results. SIRS occurred in 24 patients after surgery, whose plasma Gln level was significantly lower (P<0.01) and L/M ratio significantly higher (P<0.01) than that in the SIRS-free patients 2 days after the operation. Five of the 26 SIRS patients showed positive PCR results, while none of the 16 non-SIRS patients were positive, but this difference was not statistically significant (P>0.05).


CONCLUSIONS
Decreased plasma Gln and increased intestinal mucosal permeability are closely related to postoperative bacterial translocation and the intestinal mucosal barrier dysfunction, which may contribute to the occurrence of postoperative infection.
Zhang
Wen-bin
WB
Department of Emergency Medicine, First Affiliated Hospital of Jinan University, Guangzhou 510630, China. xxzhangwenbin@163.com
Jiang
Hai-ping
HP
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D018988:Bacterial Translocation / Q000502:physiology*; D004269:DNA, Bacterial / Q000097:blood; D005260:Female; D005973:Glutamine / Q000097:blood; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000503:physiopathology; D007421:Intestine, Small / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011183:Postoperative Complications / Q000378:metabolism*; D013312:Stress, Physiological; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
D004269:DNA, Bacterial; D005973:Glutamine