CAJ | 학술논문

目的观察早期肠内肠外营养支持对肝硬化大鼠肝部分切除术后的影响.方法采用24只雄性SD大鼠随机分为3组:A组正常大鼠肠内营养;B组肝硬化大鼠肠内营养;C组肝硬化大鼠肠外营养.3组大鼠行肝部分切除术后1 d分别进行等热量[690 kJ/(kg·d)]等氮量[1.22g/(kg·d)]营养支持,共5 d.术后6 d测定大鼠体质量、肝功能、前白蛋白、转铁蛋白、肝组织白蛋白(ALB)mRNA的表达及细胞增殖核抗原(Ki-67)蛋白表达水平.结果与术前比较,术后A组大鼠体质量增加,B、C组体质量减轻,差异有统计学意义[A:(6.16±3.28)g;B:(5.46±2.59)g;C:(6.13±3.21)g,P＜0.05).术后B、C组大鼠肝功能与A组比较,血清AST、ALT、ALP升高,ALB降低,差异均有统计学意义(P＜0.05);B组与C组比较,ALP升高,差异有统计学意义[B:(209±81)IU/L;C:(271:±92)IU/L,P＜0.05).术后B、C组大鼠血清前白蛋白和转铁蛋白与A组比较均降低,差异有统计学意义(P＜0.05);C组与B组比较,血清前白蛋白降低,差异有统计学意义[B:(161±37)mg/L;C:(133±29)mg/L,P＜0.05].术后B、C组肝组织ALB mRNA表达水平比A组下降,差异有统计学意义(A:1.46±0.12;B:1. 07±0.14;C:0.84±0.18,P＜0.05);B组与C组比较,C组肝组织ALB mRNA表达水平降低,差异有统计学意义(P＜0.05).术后A组肝组织Ki-67蛋白表达指数比B、C组高,差异有统计学意义(A:8.90±0.45;B:5.60±0.34;C:3.80±0.21,P＜0.05);而B组Ki-67指数比C组高,差异有统计学意义(P＜0.05).结论肝硬化大鼠肝部分切除术后存在明显的肝功能不全和肝再生能力下降,虽经过积极的肠内或肠外营养支持,其术后各项指标的恢复均明显差于无肝硬化的大鼠.肠内营养较肠外营养更能促进肝硬化大鼠肝部分切除术后肝脏蛋白质的合成代谢和肝再生,肠内营养途径可进一步降低与肠外营养相关的胆汁淤积并发症的发生.
목적 관찰조기장내장외영양지지대간경화대서간부분절제술후적영향.방법 채용24지웅성SD대서수궤분위3조:A조정상대서장내영양;B조간경화대서장내영양;C조간경화대서장외영양.3조대서행간부분절제술후1 d분별진행등열량[690 kJ/(kg·d)]등담량[1.22g/(kg·d)]영양지지,공5 d.술후6 d측정대서체질량、간공능、전백단백、전철단백、간조직백단백(ALB)mRNA적표체급세포증식핵항원(Ki-67)단백표체수평.결과 여술전비교,술후A조대서체질량증가,B、C조체질량감경,차이유통계학의의[A:(6.16±3.28)g;B:(5.46±2.59)g;C:(6.13±3.21)g,P＜0.05).술후B、C조대서간공능여A조비교,혈청AST、ALT、ALP승고,ALB강저,차이균유통계학의의(P＜0.05);B조여C조비교,ALP승고,차이유통계학의의[B:(209±81)IU/L;C:(271:±92)IU/L,P＜0.05).술후B、C조대서혈청전백단백화전철단백여A조비교균강저,차이유통계학의의(P＜0.05);C조여B조비교,혈청전백단백강저,차이유통계학의의[B:(161±37)mg/L;C:(133±29)mg/L,P＜0.05].술후B、C조간조직ALB mRNA표체수평비A조하강,차이유통계학의의(A:1.46±0.12;B:1. 07±0.14;C:0.84±0.18,P＜0.05);B조여C조비교,C조간조직ALB mRNA표체수평강저,차이유통계학의의(P＜0.05).술후A조간조직Ki-67단백표체지수비B、C조고,차이유통계학의의(A:8.90±0.45;B:5.60±0.34;C:3.80±0.21,P＜0.05);이B조Ki-67지수비C조고,차이유통계학의의(P＜0.05).결론 간경화대서간부분절제술후존재명현적간공능불전화간재생능력하강,수경과적겁적장내혹장외영양지지,기술후각항지표적회복균명현차우무간경화적대서.장내영양교장외영양경능촉진간경화대서간부분절제술후간장단백질적합성대사화간재생,장내영양도경가진일보강저여장외영양상관적담즙어적병발증적발생.
Objective To evaluate the impact of early enteral and parenteral nutrition support in rats with liver cirrhosis after partial hepatectomy. Methods Twenty-four rats were randomly divided into three groups in this prospective randomized control study. From postoperative day ( POD) 1 to 5, all of these groups (group A, normal EN; group B, cirrhotic EN; group C, cirrhotic PN) after receiving partial hepatectomy were nutritionally supported with equal amount of calorie [690 kj/(kg·d)] and nitrogen [1.22 g/(kg·d)] content. Moreover, on the POD 6, parameters like weight, liver function, prealbumin and transferrin were tested, as well as level of liver albumin mRNA detected by reverse transcription-poly-merase chain reaction (RT-PCR) and morphological examinations, like HE stain and immunohistochemical stain assessed by index of Ki-67 protein. Results Compared with the preoperative baseline on the POD 6, group A gained weight, but not in the other groups [group A; (6.16 ±3.28) g; group B: (5.46 ±3.59) g; groupC; (6.13 ±3.21) g,P<0.05]. The levels of serum AST, ALT and ALP after partial hepatectomy were significantly higher in groups B and C than in group A (P <0.05). Serum level of ALP was higher in group C (271 ±92) IU/L than in group B [ (209 ± 81) IU/L.P <0.05 ]. Levels of serum prealbumin and transferring were significantly declined after partial hepatectomy in groups B and C as compared with group A (P<0.05). The levels of prealbumin were significantly higher in group B (161 ±37) mg/L than in group C [ (133 ±29) mg/L.P <0.05 ]. The levels of albumin mRNA and index of Ki-67 in the murine liver were compared among these groups. Albumin mRNA was suppressed in groups B and C as compared with group A, as well as that in group C as compared with group B (A: 1.46 ±0.12; B: 1.07 ±0.14; C; 0.84 ± 0.18, P < 0.05). Index of Ki-67 was higher in group A than in groups B and C, as well as that in group B than in group C (A: 8.90 ±0.45; B: 5.60 ±0.34; C: 3.80 ±0.21 ,P <0.05). Conclusion Active nutrition support, through EN nor PN cannot efficiently promote liver regeneration and relieve liver malfunction in cirrhotic rats rather than in normal ones after partial hepatectomy, represented by delayed restoration of various parameters reflecting liver function. Nevertheless, compared with PN, standard EN revealed some advantages though. Besides reducing risk of PN-related cholestasis, EN can better the restoration by promoting protein synthesis and tissue regeneration in the postoperative liver.