CAJ | 학술논문

目的观察添加鱼油脂肪乳剂的肠外营养(PN)对重症急性胰腺炎(SAP)患者早期肠黏膜屏障功能的影响.方法将确诊为SAP的46例患者随机分为研究组和对照组,使用等氮、等热量PN共6d,热量为108.7 kJ/(kg·d),研究组给予鱼油0.2 g/(kg·d)以及物理混合的中长链脂肪乳0.8g/(kg·d).对照组给予物理混合的中长链脂肪乳1.0 g/(kg·d).分别在试验开始前和试验第7天早晨抽静脉血测定患者血浆内毒素、血浆D-乳酸水平和肠脂肪酸结合蛋白(I-FABP)的水平.结果 46例SAP患者发病72h内胃肠功能评分、血浆内毒素、D-乳酸水平及血清I-FABP均明显升高,两组差异无统计学意义(P＞0.05).治疗7d后,两组患者上述指标均下降,但鱼油组与对照组比较,胃肠功能评分、血浆内毒素、D-乳酸水平及肠脂肪酸结合蛋白水平下降更显著,差异均有统计学意义(P＜0.05)(1.61±0.79比2.02 ±0.68;0.24±0.15比0.42±0.11;2.89±1.23比3.95±1.17;77.5±38.4比100.5 ±42.8).结论 ω-3鱼油脂肪乳剂能降低SAP患者血浆内毒素、D-乳酸水平以及I-FABP的浓度,从而降低肠黏膜的通透性,保护肠黏膜屏障.
목적 관찰첨가어유지방유제적장외영양(PN)대중증급성이선염(SAP)환자조기장점막병장공능적영향.방법 장학진위SAP적46례환자수궤분위연구조화대조조,사용등담、등열량PN공6d,열량위108.7 kJ/(kg·d),연구조급여어유0.2 g/(kg·d)이급물리혼합적중장련지방유0.8g/(kg·d).대조조급여물리혼합적중장련지방유1.0 g/(kg·d).분별재시험개시전화시험제7천조신추정맥혈측정환자혈장내독소、혈장D-유산수평화장지방산결합단백(I-FABP)적수평.결과 46례SAP환자발병72h내위장공능평분、혈장내독소、D-유산수평급혈청I-FABP균명현승고,량조차이무통계학의의(P＞0.05).치료7d후,량조환자상술지표균하강,단어유조여대조조비교,위장공능평분、혈장내독소、D-유산수평급장지방산결합단백수평하강경현저,차이균유통계학의의(P＜0.05)(1.61±0.79비2.02 ±0.68;0.24±0.15비0.42±0.11;2.89±1.23비3.95±1.17;77.5±38.4비100.5 ±42.8).결론 ω-3어유지방유제능강저SAP환자혈장내독소、D-유산수평이급I-FABP적농도,종이강저장점막적통투성,보호장점막병장.
Objective To evaluate the protective effect of omega-3 fish oil on the intestinal mucosal barrier with severe acute pancreatitis (SAP).Methods Forty Six SAP patients were enrolled (23 patients in each group) and received total parenteral nutrition (TPN) for 6 days,providing 0.8 g/(kg· d)soybean oil +0.2 g/(kg·d) ω-3 FAs based fat (FO group) or 1.0 g/(kg·d) standard soybean-oil based fat (SO group).The levels of plasma endotoxin,D-lactate and serum I-FABP expression were measured before and 7 days day after TPN.Results Forty-six patients included had significantly higher plasma level of endotoxin and D-lactate,and higher serum I-FABP concentration in the first 72 h (P ＞ 0.05).At 7th day aforementionged indexes were significantly decreased in all SAP patients.Gastrointestinal function score,plasma endotoxin and D-lactate,and serum I-FABP concentrations in FO group were significantly lower than in SO group (P ＜ 0.05,1.61 ± 0.79 vs.2.02 ± 0.68 ; 0.24 ± 0.15 vs.0.42 ± 0.11 ; 2.89 ±1.23 vs.3.95 ± 1.17 ; 77.5 ± 38.4 vs.100.5 ± 42.8).Conclusion Omega-3 fish oil supplementation reduces plasma endotoxin and D-lactate,and serum I-FABP concentrations,protects the intestinal mucosal barrier,and thereby decreases intestinal mucosal permeability in SAP.