甘露醇的检测与分析.pdf

第42卷第2期第223页
华中科技大学学报(医学版
2013年4月
Acta Med Univ Sci Techno] Huazhong
2013
头孢克洛血清病样反应患儿血浆D乳酸和
尿乳果糖/甘露醇的检测与分析
向贇',张振心,蔡小芳2,汪在华2,王晓梅,陈红波,郑义
武汉市妇女儿童医疗保健中心检验部2重症医学科,武汉430016
3清华大学深圳研究生院生命科学部,深圳518055
摘要:目的探讨头孢克洛血清病样反应患儿血浆D乳酸和尿乳果糖/甘露醇的变化及其临床意义。方法选择
42例用头孢克洛治疗后发生血清病样反应( SSLR)的上呼吸道感染患儿为SLR阳性组,40例用头孢克洛治疗后未发
生SSLR的上感患儿为SSIR阴性组,同时选择30例健康儿童作为正常对照组。在上呼吸道感染患儿口服头孢克洛后
的第7、9、11、13、15天,利用改良酶学分光光度法和电化学高效液相色谱法分别检测血浆D乳酸水平和尿乳果糖/甘露
醇(L/M)比值。对照组儿童除不服用头孢克洛外,其它实验情况与两研究组一致。结果 SSLR阳性组、阴性组及对照
组的血浆D乳酸结果比较差异均无统计学意义(均P>0.05)。而SSIR阳性组患儿的尿L/M从口服头孢克洛后的第7
天至第13天逐渐增加,第13天达到最高峰,第13天至第15天尿L/M开始下降。SSLR阳性组患儿第7、9、11、13、15
天的尿L/M均比阴性组和对照组高,差异均有统计学意义(均P<0.05);SSLR阴性组和对照组儿童尿L/M结果比较
差异无统计学意义(P>0.05)。结论服用头孢克洛可导致部分患儿产生SSLR,并影响其肠道屏障功能的变化。针对
该类不良反应的监测方法中,尿L/M比值的监测比血浆乳酸的监测结果更为敏感和可靠
关键词:头孢克洛;血清病样反应;肠道屏障功能;D乳酸;乳果糖/甘露醇
中图分类号:R593.1DOI:10.3870/j.isn.1672-0741.2013.02.022
Detection and Analysis of Plasma D-lactate and Urinary Lactulose/Mannitol in Children with
Serum Sickness-like Reactions after Cefaclor Treatment
Xiang Yun, Zhang Zhen, Cai Xiaofang'et al
2 Debartment of Medical Laboratory, Critical Care Medicine, Wuhan Medical and Health Center for
Women and Children, Wuhan 430016, China
Abstract Objective To examine the changes of plasma D-lactate levels and urinary lactulose/mannitol(L/M) ratios in
children with serum sickness-like reactions(SSLR) from cefaclor and to explore its clinical significance. Methods A total of 82
pediatric patients with upper respiratory tract infection following cefaclor therapy were divided into SSLR positive gr
SSLR negative group based on the presence or absence of
R after taking cefaclor, and 30 healthy volunteers served as contro
group. Plasma D-lactate levels and urinary L/M ratios were determined using enzymatic spectrophotometry and high-perform
ance liquid chromatography, respectively on day 7, 9, 11, 13, and 15 after oral administration of cefaclor. Children in control
group were given the same measurements after enrollment in this study. Results From days 7 to 13, the urinary
hildren with SSI_R was gradually increased and reached a peak on day 13. There were significant differences in the urinary
M ratio between SSLR positive group and SSLR negative group or control group 7,9, 11, 13 and 15 days after cefaclor therapy
( P< 0.05).No statistically significant ifference was found in urinary L/M between SSLR negative group and control
group. These existed no significant difference in plasma D-lactate level among the three groups(P>0.05). Conclusion Cefaclor
administration leads to serum sickness-like reaction and impairs the intestinal barrier in some children Urinary L/M ratio is
more sensitive and reliable than plasma D-lactate in predicting occurrence of SSLR from cefaclor
Key words cefaclor; serum sickness-like reactions intestinal mucosal permeability; D-lactate; lactulose/mannitol
第二代头孢类抗生素头孢克洛( cefaclor)是在广泛应用,特别是应用于临床儿科感染性疾病如软
1979年才被应用于临床的。此后,由于其口感好,组织、呼吸道及泌尿道等感染的治疗。但随着该抗
且能治愈多种常见的细菌性感染疾病,因而被临床生素在临床的广泛使用,其所导致的副作用也日益
向赟,男,1967年生,副教授,副主任医师, E-mail: xiangyun5272008
显现出来。因临床表现与血清病极为相似,因此
1988年被命名为血清病样反应( serum sickness-
?通讯作者, Corresponding author, E-mail: zhangzhen20092010@ya-
hoo. cn
like reactions,SSLR),其临床特征表现为口服头孢