目的 探讨结构脂肪乳与物理混合的中长链脂肪乳对急性坏死性胰腺炎(ANP)患者肝肾功能及脂肪代谢的影响.方法 选取2012年1月至2014年6月解放军总医院收治的30例ANP患者进行前瞻性研究.采用随机、双盲对照研究方法,通过随机数字表法将入组患者分为试验组和对照组,每组15例.两组患者接受≥5 d等氮等热量肠外营养支持治疗.其中试验组采用结构脂肪乳,对照组采用物理混合的中长链脂肪乳.在行营养支持治疗前、治疗后1、3、5 d抽取患者静脉血,测定ALT、AST、GGT、ALP、Cr、BUN、TG和TC水平.正态分布的计量资料采用(x)±s表示,偏态分布的计量资料采用M(范围)表示,采用独立样本t检验或重复测量方差分析,计数资料采用x2检验.结果 筛选出符合研究条件患者共30例.两组患者ALT、AST、GGT、ALP、Cr、BUN、TG、TC水平于营养支持治疗前、治疗后1、3、5d内在一定范围内变化.试验组患者ALT、AST、GGT、ALP、Cr、BUN、TC分别由治疗前29.0 U/L、25.4 U/L、83.2 U/L、(193±115) U/L、(124±97)μmol/L、(8±6) mmol/L、(2.4±1.1)mmol/L变化为治疗后5d的29.4 U/L、33.0 U/L、77.7 U/L、(172±74) U/L、(117±103) μmol/L、(8±5)mmol/L、(2.3±1.0) mmol/L;对照组患者上述指标分别由治疗前23.8 U/L、22.9 U/L、96.2 U/L、(148±108) U/L、(82±57) μmol/L、(9±7)mmol/L、(2.5 ±0.7) mmol/L变化为21.3 U/L、24.5 U/L、127.4 U/L、(179±126) U/L、(80±54) μmol/L、(10±6) mmol/L、(2.4±0.8)mmol/L.两组各指标营养支持治疗前后变化趋势比较,差异无统计学意义(F=0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).试验组患者TG由治疗前(1.5±0.6) mmol/L变化为治疗后5d的(1.5±0.7) mmol/L,其中治疗后l dTG水平较治疗前升高,至治疗后3、5 dTG水平恢复到治疗前水平;对照组患者TG治疗前(1.5±0.6) mmol/L变化为治疗后5d的(2.4±0.6) mmol/L,其中治疗后1 dTG水平较治疗前升高,至治疗后3、5 dTG水平仍高于治疗前水平.两组患者行营养支持治疗前后TG变化趋势比较,差异有统计学意义(F=7.940,P＜0.05).结论 ANP患者行肠外营养支持治疗,结构脂肪乳和物理混合的中长链脂肪乳对患者肝肾功能没有影响,而对患者TG的代谢,结构脂肪乳影响要小于中长链脂肪乳.临床试验注册:在大学医院医疗信息网络(UMIN)临床试验注册中心注册,注册编号:UMIN000016958.
目的 探討結構脂肪乳與物理混閤的中長鏈脂肪乳對急性壞死性胰腺炎(ANP)患者肝腎功能及脂肪代謝的影響.方法 選取2012年1月至2014年6月解放軍總醫院收治的30例ANP患者進行前瞻性研究.採用隨機、雙盲對照研究方法,通過隨機數字錶法將入組患者分為試驗組和對照組,每組15例.兩組患者接受≥5 d等氮等熱量腸外營養支持治療.其中試驗組採用結構脂肪乳,對照組採用物理混閤的中長鏈脂肪乳.在行營養支持治療前、治療後1、3、5 d抽取患者靜脈血,測定ALT、AST、GGT、ALP、Cr、BUN、TG和TC水平.正態分佈的計量資料採用(x)±s錶示,偏態分佈的計量資料採用M(範圍)錶示,採用獨立樣本t檢驗或重複測量方差分析,計數資料採用x2檢驗.結果 篩選齣符閤研究條件患者共30例.兩組患者ALT、AST、GGT、ALP、Cr、BUN、TG、TC水平于營養支持治療前、治療後1、3、5d內在一定範圍內變化.試驗組患者ALT、AST、GGT、ALP、Cr、BUN、TC分彆由治療前29.0 U/L、25.4 U/L、83.2 U/L、(193±115) U/L、(124±97)μmol/L、(8±6) mmol/L、(2.4±1.1)mmol/L變化為治療後5d的29.4 U/L、33.0 U/L、77.7 U/L、(172±74) U/L、(117±103) μmol/L、(8±5)mmol/L、(2.3±1.0) mmol/L;對照組患者上述指標分彆由治療前23.8 U/L、22.9 U/L、96.2 U/L、(148±108) U/L、(82±57) μmol/L、(9±7)mmol/L、(2.5 ±0.7) mmol/L變化為21.3 U/L、24.5 U/L、127.4 U/L、(179±126) U/L、(80±54) μmol/L、(10±6) mmol/L、(2.4±0.8)mmol/L.兩組各指標營養支持治療前後變化趨勢比較,差異無統計學意義(F=0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).試驗組患者TG由治療前(1.5±0.6) mmol/L變化為治療後5d的(1.5±0.7) mmol/L,其中治療後l dTG水平較治療前升高,至治療後3、5 dTG水平恢複到治療前水平;對照組患者TG治療前(1.5±0.6) mmol/L變化為治療後5d的(2.4±0.6) mmol/L,其中治療後1 dTG水平較治療前升高,至治療後3、5 dTG水平仍高于治療前水平.兩組患者行營養支持治療前後TG變化趨勢比較,差異有統計學意義(F=7.940,P＜0.05).結論 ANP患者行腸外營養支持治療,結構脂肪乳和物理混閤的中長鏈脂肪乳對患者肝腎功能沒有影響,而對患者TG的代謝,結構脂肪乳影響要小于中長鏈脂肪乳.臨床試驗註冊:在大學醫院醫療信息網絡(UMIN)臨床試驗註冊中心註冊,註冊編號:UMIN000016958.
목적 탐토결구지방유여물리혼합적중장련지방유대급성배사성이선염(ANP)환자간신공능급지방대사적영향.방법 선취2012년1월지2014년6월해방군총의원수치적30례ANP환자진행전첨성연구.채용수궤、쌍맹대조연구방법,통과수궤수자표법장입조환자분위시험조화대조조,매조15례.량조환자접수≥5 d등담등열량장외영양지지치료.기중시험조채용결구지방유,대조조채용물리혼합적중장련지방유.재행영양지지치료전、치료후1、3、5 d추취환자정맥혈,측정ALT、AST、GGT、ALP、Cr、BUN、TG화TC수평.정태분포적계량자료채용(x)±s표시,편태분포적계량자료채용M(범위)표시,채용독립양본t검험혹중복측량방차분석,계수자료채용x2검험.결과 사선출부합연구조건환자공30례.량조환자ALT、AST、GGT、ALP、Cr、BUN、TG、TC수평우영양지지치료전、치료후1、3、5d내재일정범위내변화.시험조환자ALT、AST、GGT、ALP、Cr、BUN、TC분별유치료전29.0 U/L、25.4 U/L、83.2 U/L、(193±115) U/L、(124±97)μmol/L、(8±6) mmol/L、(2.4±1.1)mmol/L변화위치료후5d적29.4 U/L、33.0 U/L、77.7 U/L、(172±74) U/L、(117±103) μmol/L、(8±5)mmol/L、(2.3±1.0) mmol/L;대조조환자상술지표분별유치료전23.8 U/L、22.9 U/L、96.2 U/L、(148±108) U/L、(82±57) μmol/L、(9±7)mmol/L、(2.5 ±0.7) mmol/L변화위21.3 U/L、24.5 U/L、127.4 U/L、(179±126) U/L、(80±54) μmol/L、(10±6) mmol/L、(2.4±0.8)mmol/L.량조각지표영양지지치료전후변화추세비교,차이무통계학의의(F=0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).시험조환자TG유치료전(1.5±0.6) mmol/L변화위치료후5d적(1.5±0.7) mmol/L,기중치료후l dTG수평교치료전승고,지치료후3、5 dTG수평회복도치료전수평;대조조환자TG치료전(1.5±0.6) mmol/L변화위치료후5d적(2.4±0.6) mmol/L,기중치료후1 dTG수평교치료전승고,지치료후3、5 dTG수평잉고우치료전수평.량조환자행영양지지치료전후TG변화추세비교,차이유통계학의의(F=7.940,P＜0.05).결론 ANP환자행장외영양지지치료,결구지방유화물리혼합적중장련지방유대환자간신공능몰유영향,이대환자TG적대사,결구지방유영향요소우중장련지방유.림상시험주책:재대학의원의료신식망락(UMIN)림상시험주책중심주책,주책편호:UMIN000016958.
Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958
