Lihua Wu, Ya Gao, Ruijie Zhou, Ping Xiao, Zhen Zhang, Bo Li, Agostino Pierro, Long Li, Qian Jiang, Qi Li
{"title":"血浆带蛋白对术后先天性巨结肠相关小肠结肠炎的预测价值。","authors":"Lihua Wu, Ya Gao, Ruijie Zhou, Ping Xiao, Zhen Zhang, Bo Li, Agostino Pierro, Long Li, Qian Jiang, Qi Li","doi":"10.1136/wjps-2025-001057","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hirschsprung's disease (HSCR) is a functional obstruction of the gastrointestinal tract characterized by abdominal distension, constipation, and vomiting. The protein zonulin serves as a biomarker for intestinal permeability. We sought to explore the changes in plasma zonulin levels in patients with HSCR and to assess its predictive role in the development of postoperative Hirschsprung-associated enterocolitis (HAEC).</p><p><strong>Methods: </strong>There are 60 patients with HSCR were recruited for this study, categorized into short-segment disease (S-HSCR) (<i>n</i>=33), long-segment disease (L-HSCR) (<i>n</i>=15), and total colonic aganglionosis (TCA) (<i>n</i>=12). Venous blood samples were taken from all participants before and after pull-through surgery. Plasma concentrations of zonulin were determined using an ELISA. Immunohistochemistry (IHC) analysis was conducted to evaluate the expression of zonula occludens-1 (ZO-1) and occludin in colonic tissues. Hematoxylin and Eosin stained (H&E-stained) sections were used to evaluate the degree of inflammation in the dilated (ganglionic) segment. Postoperative outcomes were assessed through a combination of online questionnaires and telephone interviews. Diagnostic threshold for HAEC was based on clinical symptom sets and the HAEC scoring system developed previously.</p><p><strong>Results: </strong>Preoperative zonulin levels in patients with TCA were statistically lower than those in patients with S-HSCR (<i>p</i>=0.008) and L-HSCR (<i>p</i>=0.028). The incidence of postoperative HAEC was 16.7%, 57.1%, and 14.3% in TCA, L-HSCR, and S-HSCR groups, respectively. Patients who experienced an increase in plasma zonulin levels of more than 1.5 times those on the first day after surgery had a higher risk of developing HAEC (<i>p</i>=0.005). IHC staining further confirmed decreased expression of ZO-1 and occludin in colonic tissues of patients with HSCR who experienced postoperative HAEC.</p><p><strong>Conclusion: </strong>Preoperative zonulin levels were lowest in the TCA group. The change in zonulin levels on the first day after surgery can serve as a useful indicator for predicting the risk of postoperative HAEC occurrence.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 3","pages":"e001057"},"PeriodicalIF":1.3000,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228470/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictive value of plasma zonulin for postoperative Hirschsprung-associated enterocolitis.\",\"authors\":\"Lihua Wu, Ya Gao, Ruijie Zhou, Ping Xiao, Zhen Zhang, Bo Li, Agostino Pierro, Long Li, Qian Jiang, Qi Li\",\"doi\":\"10.1136/wjps-2025-001057\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hirschsprung's disease (HSCR) is a functional obstruction of the gastrointestinal tract characterized by abdominal distension, constipation, and vomiting. The protein zonulin serves as a biomarker for intestinal permeability. We sought to explore the changes in plasma zonulin levels in patients with HSCR and to assess its predictive role in the development of postoperative Hirschsprung-associated enterocolitis (HAEC).</p><p><strong>Methods: </strong>There are 60 patients with HSCR were recruited for this study, categorized into short-segment disease (S-HSCR) (<i>n</i>=33), long-segment disease (L-HSCR) (<i>n</i>=15), and total colonic aganglionosis (TCA) (<i>n</i>=12). Venous blood samples were taken from all participants before and after pull-through surgery. Plasma concentrations of zonulin were determined using an ELISA. Immunohistochemistry (IHC) analysis was conducted to evaluate the expression of zonula occludens-1 (ZO-1) and occludin in colonic tissues. Hematoxylin and Eosin stained (H&E-stained) sections were used to evaluate the degree of inflammation in the dilated (ganglionic) segment. Postoperative outcomes were assessed through a combination of online questionnaires and telephone interviews. Diagnostic threshold for HAEC was based on clinical symptom sets and the HAEC scoring system developed previously.</p><p><strong>Results: </strong>Preoperative zonulin levels in patients with TCA were statistically lower than those in patients with S-HSCR (<i>p</i>=0.008) and L-HSCR (<i>p</i>=0.028). The incidence of postoperative HAEC was 16.7%, 57.1%, and 14.3% in TCA, L-HSCR, and S-HSCR groups, respectively. Patients who experienced an increase in plasma zonulin levels of more than 1.5 times those on the first day after surgery had a higher risk of developing HAEC (<i>p</i>=0.005). IHC staining further confirmed decreased expression of ZO-1 and occludin in colonic tissues of patients with HSCR who experienced postoperative HAEC.</p><p><strong>Conclusion: </strong>Preoperative zonulin levels were lowest in the TCA group. The change in zonulin levels on the first day after surgery can serve as a useful indicator for predicting the risk of postoperative HAEC occurrence.</p>\",\"PeriodicalId\":23823,\"journal\":{\"name\":\"World Journal of Pediatric Surgery\",\"volume\":\"8 3\",\"pages\":\"e001057\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-07-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228470/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Pediatric Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/wjps-2025-001057\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Pediatric Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/wjps-2025-001057","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
Predictive value of plasma zonulin for postoperative Hirschsprung-associated enterocolitis.
Background: Hirschsprung's disease (HSCR) is a functional obstruction of the gastrointestinal tract characterized by abdominal distension, constipation, and vomiting. The protein zonulin serves as a biomarker for intestinal permeability. We sought to explore the changes in plasma zonulin levels in patients with HSCR and to assess its predictive role in the development of postoperative Hirschsprung-associated enterocolitis (HAEC).
Methods: There are 60 patients with HSCR were recruited for this study, categorized into short-segment disease (S-HSCR) (n=33), long-segment disease (L-HSCR) (n=15), and total colonic aganglionosis (TCA) (n=12). Venous blood samples were taken from all participants before and after pull-through surgery. Plasma concentrations of zonulin were determined using an ELISA. Immunohistochemistry (IHC) analysis was conducted to evaluate the expression of zonula occludens-1 (ZO-1) and occludin in colonic tissues. Hematoxylin and Eosin stained (H&E-stained) sections were used to evaluate the degree of inflammation in the dilated (ganglionic) segment. Postoperative outcomes were assessed through a combination of online questionnaires and telephone interviews. Diagnostic threshold for HAEC was based on clinical symptom sets and the HAEC scoring system developed previously.
Results: Preoperative zonulin levels in patients with TCA were statistically lower than those in patients with S-HSCR (p=0.008) and L-HSCR (p=0.028). The incidence of postoperative HAEC was 16.7%, 57.1%, and 14.3% in TCA, L-HSCR, and S-HSCR groups, respectively. Patients who experienced an increase in plasma zonulin levels of more than 1.5 times those on the first day after surgery had a higher risk of developing HAEC (p=0.005). IHC staining further confirmed decreased expression of ZO-1 and occludin in colonic tissues of patients with HSCR who experienced postoperative HAEC.
Conclusion: Preoperative zonulin levels were lowest in the TCA group. The change in zonulin levels on the first day after surgery can serve as a useful indicator for predicting the risk of postoperative HAEC occurrence.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
