Relationship between intestinal mucosal barrier injury and levels of serum diamine oxidase and TLR9,intestinal flora and its metabolites in severe acute pancreatitis
Objective To explore the relationship of intestinal mucosal barrier damage with the levels of serum diamine oxidase(DAO)and toll-like receptor 9(TLR9),intestinal flora and their metabolites in severe acute pancreatitis(AP),providing a reference for the treatment.Methods A total of 107 patients with AP who underwent diagnosis and treatment in our hospital from January 2020 to January 2022 were selected as the research group,and further divided into mild/mod-erate disease group(n=51)and severe disease group(n=56)based on their severity.Another 50 volunteers who underwent health examinations in our hospital were selected as the control group.The serum levels of DAO and TLR9,intestinal mu-cosal barrier damage indicators(endotoxin,D-lactic acid,Lactulose/Mannitol ratio),intestinal flora and intestinal metabol-ite levels at different time points were compared between groups.Results Compared with the control group,the levels of serum DAO,TLR9,endotoxin and D-lactic acid,Lactulose/Mannitol ratio,and counts of Enterococcus and yeast in the re-search group increased,while the levels of Bifidobacteria,Peptococcus,Lactobacillus,propionic acid,butyric acid,and acetic acid decreased(all P＜0.05).The levels of DAO and TLR9 in the severe and mild/moderate disease groups showed a trend of first increasing and then decreasing at 24,48,and 72 hours of admission,and the levels of DAO and TLR9 in the severe disease group were higher than those in the mild/moderate disease group at all time points(all P＜0.05).The levels of endotoxin and D-lactic acid,Lactulose/Mannitol ratio in severe disease group and mild/moderate disease group showed a trend of first increasing and then decreasing at 24,48,and 72 hours of admissiona,and those in severe disease group at each time point were higher than those in mild/moderate disease group respectively(all P＜0.05).The levels of endotoxin in patients was positively correlated with the levels of DAO,TLR9,Bifidobacteria,Enterococcus,Lactobacillus,acetic acid and butyric acid,while negatively correlated with the levels of Enterococcus and yeast,but had no significant correla-tion with the level of propionic acid.The level of D-lactic acid had no significant correlation with the levels of Bifidobac-teria,Peptococcus,Lactobacillus,acetic acid,butyric acid,Enterococcus,and yeast,but was positively correlated with the levels of DAO,TLR9 and propionic acid.The ratio of Lactulose/Mannitol was negatively correlated with the levels of Bi-fidobacteria,Enterococcus,Lactobacillus and acetic acid,while positively correlated with the levels of DAO,TLR9,yeast and butyric acid,but had no significant correlation with the level of propionic acid.Conclusion The intestinal mucosal barrier damage was more severe in patients with severe acute pancreatitis,and the levels of serum DAO,TLR9,endotoxin,D-lactic acid and Lactulose/Mannitol ratio significantly increased.The intestinal mucosal barrier injury of patients was cor-related with the levels of serum DAO,TLR9,intestinal flora and its metabolites.
Severe acute pancreatitisIntestinal mucosal barrierDiamine oxidaseIntestinal floraMetabolite
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