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Die Rolle von Biomarkern in der Diagnostik der akuten Mesenterialischämie

The role of biomarkers in the diagnostics of acute mesenteric ischemia

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An Erratum to this article was published on 17 January 2015

Zusammenfassung

Die akute Mesenterialischämie stellt auch heutzutage aufgrund ihrer hohen Letalität den behandelnden Mediziner vor eine große Herausforderung. Unspezifische Symptome in der frühen Phase der Erkrankung erschweren eine rasche Diagnose der Mesenterialischämie und nur eine frühzeitige Diagnose und Therapie kann den Patienten vor irreversibler Darmischämie, ausgedehnten Darmresektionen, Sepsis und Tod bewahren. Im Gegensatz zu beispielsweise Troponin als frühem Marker für die kardiale Ischämie ist ein zuverlässiger Marker für die Mesenterialischämie bisher nicht im klinischen Alltag etabliert. Dieser würde eine Früherkennung der Patienten in der frühen, reversiblen Phase ermöglichen.

Diese Übersichtsarbeit fasst die Pathophysiologie, Epidemiologie und klinische Symptomatik der akuten Mesenterialischämie zusammen und soll einen Überblick über mögliche Biomarker, allen voran das Serumlaktat, geben. Nur Serumlaktat wird bisher als Routineparameter zur Diagnostik der mesenterialen Ischämie verwendet.

Abstract

Acute mesenteric ischemia is a severe and challenging disease. Unspecific symptoms in the initial phase make a fast diagnosis difficult although it is of major importance to protect patients from irreversible ischemia, extended bowel resection, sepsis and death in the late phase. In contrast to troponin as an early biomarker for cardiac ischemia, a reliable biomarker for acute intestinal ischemia has not yet been identified in the current literature and clinical practice. This would allow the early identification of these critically ill patients in the initial reversible phase of acute intestinal ischemia.

This review highlights the pathophysiology, epidemiology and clinical findings of acute mesenteric ischemia and gives an overview of biomarkers which have been investigated in mesenteric ischemia with a special focus on lactate, which is the only parameter routinely used in the diagnostic setting of acute mesenteric ischemia.

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Abbreviations

AMI:

akute mesenteriale Ischämie

AMS:

Arteria mesenterica superior

ATP:

Adenosintriphosphat

CRP:

C-reaktives Protein

CT:

Computertomographie

DOR:

diagnostische Odds Ratio

I-FABP:

intestinal fatty acid binding protein

KHK:

koronare Herzerkrankung

LDH:

Laktatdehydrogenase

LR−:

likelihood ratio für einen negativen Test

LR+:

likelihood ratio für einen positiven Test

NOMI:

nichtokklusive mesenteriale Ischämie

PDH:

Pyruvatdehydrogenase

Se:

Sensitivität

SIRS:

systemic inflammatory response syndrome

Sp:

Spezifität

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Reichert, M. Hecker, R. Hörbelt, S. Lerner, J. Höller, C.M. Hecker, W. Padberg, M.A. Weigand und A. Hecker geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinik Gießen und Marburg GmbH, Standort Gießen, Rudolf Buchheim Str. 7, 35392, Gießen, Deutschland

    M. Reichert, R. Hörbelt, S. Lerner, J. Höller, W. Padberg &  A. Hecker

  2. University of Gießen Lung Center, Medizinische Klinik 2, Universitätsklinik Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland

    M. Hecker

  3. Abteilung für systemische Zellbiologie, Max Planck Institut für molekulare Physiologie, Dortmund, Deutschland

    C.M. Hecker

  4. Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Universitätsklinik Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland

    M.A. Weigand

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  1. M. Reichert
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Reichert, M., Hecker, M., Hörbelt, R. et al. Die Rolle von Biomarkern in der Diagnostik der akuten Mesenterialischämie. Chirurg 86, 47–55 (2015). https://doi.org/10.1007/s00104-014-2887-7

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