目的 研究ω-3多不饱和脂肪酸对重症急性胰腺炎(SAP)患者血清中D-乳酸水平、二胺氧化酶(DAO)活性和尿中乳果糖/甘露醇(L/M)比值的影响.方法 选取2012年8月至2014年5月山西医科大学第一医院普外科和河南省郸城县人民医院普外科SAP患者40例,采用SAS 8.0统计软件编程随机分为研究组(n=20)和对照组(n=20),对照组给予常规肠外营养(PN)支持,研究组应用鱼油脂肪乳制剂(富含ω-3多不饱和脂肪酸)替代结构脂肪乳制剂.分别于入院当天及营养支持后第1、5、10天抽取静脉血检测D-乳酸水平和DAO活性,留取尿液检测L/M.结果 两组患者PN后血中D-乳酸水平、DAO活性及尿中L/M比值均有不同程度降低.入院当天及营养支持后第1天,研究组与对照组D-乳酸水平[(7.47±0.72)mg/L比(7.31±0.54) mg/L,F=0.677,P=0.416; (7.37 ±0.68) mg/L比(7.35±0.59) mg/L,F=0.014,P=0.908]、DAO活性[(16.99±0.93) U/L比(16.83±0.82) U/L,F=0.314,P=0.579; (17.12±0.77) U/L比(17.07±0.68) U/L,F=0.068,P=0.796]及尿L/M比值(0.23±0.07比0.22±0.07,F=0.091,P=0.765;0.21 ±0.07比0.22±0.08,F=0.119,P=0.732)的差异均无统计学意义.营养支持后第5天和第10天,研究组与对照组比较,D-乳酸水平[(5.62±0.34) mg/L比(6.61±0.30) mg/L,F=95.242,P=0.000;(2.76±0.55) mg/L比(4.56 ±0.37) mg/L,F=148.052,P=0.000]、DAO活性[(7.02±0.93) U/L比(10.40±0.68) U/L,F=170.815,P=0.000; (3.32 ±0.80) U/L比(6.09±0.69) U/L,F=138.645,P=0.000]和尿L/M比值(0.57±0.08比0.82±0.07,F=112.668,P=0.000;0.19 ±0.12比0.27±0.08,F=6.551,P=0.015)显著降低.结论 临床应用富含ω-3多不饱和脂肪酸的鱼油制剂治疗SAP,可明显降低血中D-乳酸水平、DAO活性及尿L/M比值,提示ω-3多不饱和脂肪酸可保护肠黏膜屏障功能的完整性.
目的 研究ω-3多不飽和脂肪痠對重癥急性胰腺炎(SAP)患者血清中D-乳痠水平、二胺氧化酶(DAO)活性和尿中乳果糖/甘露醇(L/M)比值的影響.方法 選取2012年8月至2014年5月山西醫科大學第一醫院普外科和河南省鄲城縣人民醫院普外科SAP患者40例,採用SAS 8.0統計軟件編程隨機分為研究組(n=20)和對照組(n=20),對照組給予常規腸外營養(PN)支持,研究組應用魚油脂肪乳製劑(富含ω-3多不飽和脂肪痠)替代結構脂肪乳製劑.分彆于入院噹天及營養支持後第1、5、10天抽取靜脈血檢測D-乳痠水平和DAO活性,留取尿液檢測L/M.結果 兩組患者PN後血中D-乳痠水平、DAO活性及尿中L/M比值均有不同程度降低.入院噹天及營養支持後第1天,研究組與對照組D-乳痠水平[(7.47±0.72)mg/L比(7.31±0.54) mg/L,F=0.677,P=0.416; (7.37 ±0.68) mg/L比(7.35±0.59) mg/L,F=0.014,P=0.908]、DAO活性[(16.99±0.93) U/L比(16.83±0.82) U/L,F=0.314,P=0.579; (17.12±0.77) U/L比(17.07±0.68) U/L,F=0.068,P=0.796]及尿L/M比值(0.23±0.07比0.22±0.07,F=0.091,P=0.765;0.21 ±0.07比0.22±0.08,F=0.119,P=0.732)的差異均無統計學意義.營養支持後第5天和第10天,研究組與對照組比較,D-乳痠水平[(5.62±0.34) mg/L比(6.61±0.30) mg/L,F=95.242,P=0.000;(2.76±0.55) mg/L比(4.56 ±0.37) mg/L,F=148.052,P=0.000]、DAO活性[(7.02±0.93) U/L比(10.40±0.68) U/L,F=170.815,P=0.000; (3.32 ±0.80) U/L比(6.09±0.69) U/L,F=138.645,P=0.000]和尿L/M比值(0.57±0.08比0.82±0.07,F=112.668,P=0.000;0.19 ±0.12比0.27±0.08,F=6.551,P=0.015)顯著降低.結論 臨床應用富含ω-3多不飽和脂肪痠的魚油製劑治療SAP,可明顯降低血中D-乳痠水平、DAO活性及尿L/M比值,提示ω-3多不飽和脂肪痠可保護腸黏膜屏障功能的完整性.
목적 연구ω-3다불포화지방산대중증급성이선염(SAP)환자혈청중D-유산수평、이알양화매(DAO)활성화뇨중유과당/감로순(L/M)비치적영향.방법 선취2012년8월지2014년5월산서의과대학제일의원보외과화하남성단성현인민의원보외과SAP환자40례,채용SAS 8.0통계연건편정수궤분위연구조(n=20)화대조조(n=20),대조조급여상규장외영양(PN)지지,연구조응용어유지방유제제(부함ω-3다불포화지방산)체대결구지방유제제.분별우입원당천급영양지지후제1、5、10천추취정맥혈검측D-유산수평화DAO활성,류취뇨액검측L/M.결과 량조환자PN후혈중D-유산수평、DAO활성급뇨중L/M비치균유불동정도강저.입원당천급영양지지후제1천,연구조여대조조D-유산수평[(7.47±0.72)mg/L비(7.31±0.54) mg/L,F=0.677,P=0.416; (7.37 ±0.68) mg/L비(7.35±0.59) mg/L,F=0.014,P=0.908]、DAO활성[(16.99±0.93) U/L비(16.83±0.82) U/L,F=0.314,P=0.579; (17.12±0.77) U/L비(17.07±0.68) U/L,F=0.068,P=0.796]급뇨L/M비치(0.23±0.07비0.22±0.07,F=0.091,P=0.765;0.21 ±0.07비0.22±0.08,F=0.119,P=0.732)적차이균무통계학의의.영양지지후제5천화제10천,연구조여대조조비교,D-유산수평[(5.62±0.34) mg/L비(6.61±0.30) mg/L,F=95.242,P=0.000;(2.76±0.55) mg/L비(4.56 ±0.37) mg/L,F=148.052,P=0.000]、DAO활성[(7.02±0.93) U/L비(10.40±0.68) U/L,F=170.815,P=0.000; (3.32 ±0.80) U/L비(6.09±0.69) U/L,F=138.645,P=0.000]화뇨L/M비치(0.57±0.08비0.82±0.07,F=112.668,P=0.000;0.19 ±0.12비0.27±0.08,F=6.551,P=0.015)현저강저.결론 림상응용부함ω-3다불포화지방산적어유제제치료SAP,가명현강저혈중D-유산수평、DAO활성급뇨L/M비치,제시ω-3다불포화지방산가보호장점막병장공능적완정성.
Objective To study the influence of ω-3 polyunsaturated fatty acids on the serum D-lactate level,diamine oxidase (DAO) activity and urinary lactulose/mannitol (L/M) ratio in patients with severe acute pancreatitis (SAP).Methods A total of 40 SAP patients were enrolled from August 2012 to May 2014 in departments of general surgery of First Hospital of Shanxi Medical University and People's Hospital of Dancheng,Henan.The patients were randomly assigned into research group (n =20) and control group (n =20) using SAS 8.0 statistics software.The control group was given conventional parenteral nutrition (PN) support,while in the research group,fish oil fat emulsion (rich in ω-3 polyunsaturated fatty acids) was used instead of structured triglyceride emulsion.The changes of serum D-lactate level,DAO activity,and urinary L/M ratio were observed on the day of admission,and the 1st,5th,10th day of PN support.Results The serum D-lactate level,DAO activity and urinary L/M ratio of both groups were found decreased after PN.Upon admission and the on the 1 st day of PN,no significant differences were noted between the research group and the control group in the serum D-lactate level [(7.47±0.72) mng/Lvs.(7.31 ±0.54) mg/L,F=0.677,P=0.416; (7.370.68) mg/Lvs.(7.35± 0.59) mg/L,F =0.014,P =0.908],DAO activity [(16.99 ±0.93) U/L vs.(16.83 ±0.82) U/L,F=0.314,P=0.579; (17.12±0.77) U/Lvs.(17.07 ±0.68) U/L,F=0.068,P=0.796] and urinary L/M (0.23 ±0.07 vs.0.22±0.07,F=0.091,P =0.765 ; 0.21± 0.07 vs.0.22±0.08,F=0.119,P=0.732).On the 5th and 10th day of PN,the research group showed significantly lower compared with the control group:serum D-lactate level [(5.62 ±0.34) mg/L vs.(6.61 ±0.30) mg/L,F=95.242,P=0.000; (2.76±0.55) mg/L vs.(4.56±0.37) mg/L,F=148.052,P=0.000],DAO activity [(7.02 ± 0.93) U/Lvs.(10.40 ±0.68) U/L,F=170.815,P =0.000; (3.32±0.80) U/L vs.(6.09± 0.69) U/L,F=138.645,P=0.000],and urinary L/M (0.57±0.08 vs.0.82±0.07,F=112.668,P=0.000; 0.19±0.12 vs.0.27 ±0.08,F=6.551,P=0.015).Conclusion Clinical application offish oil emulsion rich in ω-3 polyunsaturated fatty acids in the treatment of SAP can significantly reduce the serum D-lactate level,DAO activity and urinary L/M ratio,suggesting the protective effect of ω-3 polyunsaturated fatty acids on the functional integrity of intestinal mucosal barrier.
