单用静脉大豆油脂肪乳剂对比联合应用鱼油脂肪乳剂的肠外营养对消化道肿瘤术后患者结局影响的随机、对照、双盲、多中心临床研究(摘要)

部分回顾性临床研究观察到在营养液配方中添加特异的药理营养素可能降低术后并发症,缩短术后恢复时间,但仍缺乏较大样本、前瞻性、多中心、随机对照临床研究的证据.近年来,药理营养素在肿瘤患者综合治疗中可能发挥的作用逐渐受到重视.本研究前瞻性观察了静脉用鱼油脂肪乳剂对消化道肿瘤术后患者结局和免疫功能的影响.     

脂肪乳剂对胃肠肿瘤术后早期恢复阶段营养状况的影响

目的脂肪乳剂对胃肠肿瘤患者术后早期恢复阶段营养状况及炎症指标的影响。方法选择2015年1月-2017年12月本科室收治的胃肠肿瘤患者300例为研究对象,按照随机数字表法随机分为对照组和研究组。两组患者均给予全营养的肠外营养支持。研究组营养液在对照组基础上添加了新型鱼油脂肪乳剂(Lipoplus)。比较两组患者营养指标血清白蛋白、总蛋白、前白蛋白;炎症指标中性粒细胞计数、血清C-反应蛋白(CRP),细胞因子白介素10(IL-10)、白介素6(IL-6)、肿瘤坏死因子(TNF-α)的水平变化,观察患者全身炎性反应综合征(systemic inflammatoryresponse syndrome,SIRS)和医院感染的发生情况。结果两组患者白蛋白术后第3天与第6天水平差异比较无统计学意义,前白蛋白水平在术后第3天均下降,第6天均升高,两组比较差异有统计学意义(P<0.05);术后中性粒细胞计数均下降,且研究组术后第6天低于对照组(P<0.05)。血清C-反应蛋白水平术后第3天升高,随后开始降低,两组比较差异有统计学意义(P<0.05);两组患者术后细胞因子IL-10、IL-6、TNF-α比较差异均有统计学意义(P<0.05);术后两组患者SIRS发生率、感染率比较差异有统计学意义(χ~2=23.68,7.66;均P<0.05)。结论进行胃肠肿瘤手术后在恢复患者的营养安排中可添加鱼油,其能够恢复和改善胃肠肿瘤患者的营养及其免疫状况。     

脂肪乳剂对血脂代谢的影响

３０例消化道肿瘤病人随机分为３组，术后分别输注长链，中长链或低磷脂长链脂肪乳剂，观察其对血脂代谢的影响。结果示除ＬＶ，组外，ＩＬ，ＬＦ组输注后血清甘油三酯浓度显著上长，ＩＬ组血清总胆固醇浓度可见增高，ＬＦ组无明显改变，ＬＶ组则显著降低。据此，我们认为就血脂代谢而言，消化道肿瘤病人术后短期输注脂肪乳剂，以低磷脂含量者为佳；其次，在等浓度等磷脂含量脂肪乳剂中、中长链脂肪乳剂又优于单纯长链脂肪乳剂。     

结构脂肪乳剂对胃肠肿瘤病人静息能量代谢和脂质过氧化的影响

目的:观察结构脂肪乳剂(STG)和物理混合的中长链脂肪乳剂(MCT/LCT)对胃肠肿瘤病人静息能量代谢和脂质过氧化的影响. 方法:对择期手术的胃肠道肿瘤病人64例,随机分为STG组和MCT/LCT组,于术后第2～6天分别使用STG和MCT/LCT构成的等氮、等热量PN支持,共5d.术后第1至第6天检测病人静息能量代谢、氮平衡和血清超敏C-反应蛋白,术后第6天抽取静脉血行脂质过氧化水平检测. 结果:两组病人术后静息能量代谢均较术前明显升高,STG组病人明显低于MCT/LCT组(JP＜0.05)；两组病人采用STG和MCT/LCT的PN治疗后氮平衡均有改善,而STG组病人累计氮平衡值明显高于MCT/LCT组病人(J＜0.05).STG组病人血清中丙二醛和谷胱甘肽过氧化物酶水平亦明显低于MCT/LCT组(P＜0.05). 结论:对胃肠肿瘤病人,在减轻脂质过氧化损伤和维护能量代谢稳定方面,STG比MCT/LCT更为优越.     

鱼油脂肪乳剂对胃肠肿瘤患者术后单核细胞功能的影响

目的探讨鱼油脂肪乳对胃肠肿瘤患者术后单核细胞功能的影响。方法64例胃肠道肿瘤患者采用信封法随机分为对照组（32例）和研究组（32例）,两组患者均给予含中长链脂肪乳剂肠外营养支持,研究组加用鱼油脂肪乳。于患者术后第1、3、6天分别检测人类主要组织相容性抗原-DR、单核细胞培养液白细胞介素（IL）-1β、IL-6、IL-10、肿瘤坏死因子（TNF）-α的变化。结果术后连续5d肠外营养支持后,研究组IL-1β[（1818±213）pg／L]、IL-6[（415±71）pg/L]、TNF-α[（2194±350）pg／L]含量较对照组[IL-1β：（2292±289）pg／L;IL-6：（791±163）pg／L;TNF—α：（2509±507）pg/L]显著降低（P=0．027,P=0．001,P=0．036）,但两组IL-10的差异无统计学意义。研究组外周血单核细胞人类主要组织相容性抗原-DR表达水平（76．6±15．2）％较对照组（62．3±16．8）％显著升高（P=0．029）。结论使用添加鱼油脂肪乳的肠外营养有利于改善胃肠肿瘤患者术后的单核细胞功能。     

结构脂肪乳剂对腹部中等手术后病人脂肪代谢的影响

目的:观察结构脂肪乳剂(STG)和物理混合的中/长链脂肪乳剂(MCT/LCT)对腹部中等手术后病人脂肪代谢的影响.方法:选择40例腹部中等手术后、需要肠外营养支持至少5 d以上的病人40例,按前瞻、随机、盲法、对照原则分为STG组20例和MCT/LCT组20例.术后第1 d至第5 d两组病人按等氮、等热量进行肠外营养支持.于手术前、术后第1 d营养支持前及术后第6 d的清晨6:00留取血标本检测三酰甘油和胆固醇.术后第2 d输注前与输注结束时抽取静脉血检测三酰甘油、胆固醇和游离脂肪酸.结果:与术前值相比,两组病人三酰甘油与胆固醇在术后第1 d均明显下降,术后第6 d 两组三酰甘油水平又逐渐上升.但与STG组相比,输注物理混合MCT/LCT后,病人的三酰甘油及中链脂肪酸升高幅度更大一些,而STG LCFA的升高要更明显.结论:在对术后病人三酰甘油以及中链脂肪酸的代谢影响等方面,STG影响要小于MCT/LCT;对长链脂肪酸的影响STG要大于物理混合MCT/LCT,这与STG结构特点有关.     

不同碳链脂肪乳剂对肝脏外科病人术后的影响

目的观察两种不同碳链脂肪乳剂对肝脏外科病人术后自然病程的影响。方法选择肝脏外科病人25例，随机分为两组；长链脂肪乳剂组（n＝12，简称LCT组），中／长链脂肪乳剂组（n=13，简称MCT组）。LCT组脂肪乳剂为20％Inralipid，MCT组为20％Lipofundin，连续观察1周。在术前，术后1、4、7天测定肝功能、血脂、血及尿液中肉毒碱（CNT）以及激素的变化。结果两组对肝脏酶学无明显影响。胆红素在术后1天明显升高，但MCT组随后显著下降，LCT组下降速度慢于MCT组，P＜0．05。PN期间血脂代谢无异常。CNT术后明显升高，尿排出减少，术后7天LCT组血CNT高于MCT组，尿CNT低于MCT组，P＜0．05。血皮质醇、胰岛素（I）、G以及G／I术后第1天均明显升高，随后逐渐下降，而LCT组术后7天，胰高糖素（G）以及G／I维持在较高水平。血糖术后明显升高，术后4、7天，LCT组持续在较高水平，MCT组已属正常。结论MCT／LCT乳剂可能是肝脏外科病人更为理想的脂肪能源。     

脂肪乳剂对肝硬变术后脂肪代谢的影响

16例肝硬变术后随机分成两组,静脉输注不同用量及比例的脂肪乳剂。第一组平均输注0.82g·kg~(-1)·d~(-1),占总热卡42％(n=10);第二组平均输注1.72g·kg~(-1)·d~(-1),占总热卡52％(n=6),行短期术后5天营养支持。观察血脂、载脂蛋白、酮体比及脂肪廓清等的变化情况。结果提示肝硬变患者肝功能轻、中度异常的情况下,术后应用1.72g·kg~(-1)·d~(-1)的脂肪乳剂不但对肝脏功能无害反而有利。     

脂肪乳剂对胃癌病人术后免疫功能的影响

将31例因胃癌行全胃切除术后静脉营养病人随机分为无脂组、低脂组、高脂组，观察术前、术后T淋巴细胞亚群、IL－2、IL－6、sIL－2R变化。结果术前、术后1、3、5天各组间无差异，术后7天，高脂组CD4低于其它两组，CD4／CD8降低；IL－2、IL－6比其它两组低；sIL－2R升高。提示大剂量长期输注脂肪乳剂可能对免疫功能有影响，而低脂组没有。     

天然β胡萝卜素对肿瘤患者放,化疗后免疫功能的影响

为探讨天然β胡萝卜素对放、化疗后肿瘤患者免疫功能的影响，我们对１１０名放、化疗后肿瘤患者采用了多中心前瞻性双盲方法进行了临床研究。结果表明，天然β胡萝卜素对放、化疗后肿瘤患者血清中ＩｇＧ、ＩｇＭ浓度、静脉血中淋巴细胞转化率，以及旧结核菌素皮肤迟发性超敏试验等体液和细胞免疫功能的指标均有明显的提高作用。     

Palm oil versus hydrogenated soybean oil: effects on serum lipids and plasma haemostatic variables

The purpose of this study was to test if replacement of trans fatty acids by palmitic acid in an experimental margarine results in unfavourable effects on serum lipids and haemostatic factors. We have compared the effects of three different margarines, one based on palm oil (PALM-margarine), one based on partially hydrogenated soybean oil (TRANS- margarine) and one with a high content of polyunsaturated fatty acids (PUFA-margarine), on serum lipids in 27 young women. In nine of the participants fasting levels and diurnal postprandial levels of haemostatic variables on the 3 diets were compared. The sum of 12:0, 14:0, 16:0 provided 11% of energy (E%) in the PALM diet, the same as the sum of 12:0, 14:0, 16:0 and trans fatty acids in the TRANS-diet. Oleic acid provided 10-11E% in all three diets, while PUFA provided 5.7, 5.5 and 10.2 E%, respectively. Total fat provided 30-31% and the test margarines 26% of total energy in all three diets. Each of the diets was consumed for 17 days in a crossover design. There were no significant differences in total cholesterol, LDL-cholesterol and apoB between the TRANS- and the PALM-diet. HDL-cholesterol and apoA-I were significantly higher on the PALM-diet compared to the TRANS-diet while the ratio of LDL- to HDL-cholesterol was lower, although not significantly (P = 0.077) on the PALM-diet. Total cholesterol, LDL-cholesterol and apoB were significantly lower on the PUFA-diet compared to the two other diets. HDL-cholesterol was not different on the PALM- and the PUFA-diet while it was significantly lower on the TRANS-diet compared to the PUFA-diet. Triglycerides and Lp(a) were not different among the three diets. The diurnal postprandial state level of tissue plasminogen activator (t-PA) activity was significantly decreased on the TRANS-diet compared to the PALM-diet. t-PA activity was also decreased on the PUFA-diet compared to PALM-diet although not significantly (P=0.07). There were no significant differences in neither fasting levels or in circadian variation of t-PA antigen, PAI-1 activity, PAI-1 antigen, factor VII coagulant activity or fibrinogen between the three diets. Our results suggest that dietary palm oil may have a more favourable effect on the fibrinolytic system compared to partially hydrogenated soybean oil. We conclude that from a nutritional point of view, palmitic acid from palm oil may be a reasonable alternative to trans fatty acids from partially hydrogenated soybean oil in margarine if the aim is to avoid trans fatty acids. A palm oil based margarine is, however, less favourable than one based on a more polyunsaturated vegetable oil.     

Immune function during intravenous administration of a soybean oil emulsion

The effect of a continuous infusion of a soybean oil emulsion on immune function was evaluated in 40 malnourished patients who were randomized to receive preoperatively either a 25% glucose-5% amino acid solution (group G) or a 15% glucose-3.3% Intralipid-5% amino acid solution (group G-F). Average length of total parenteral nutrition (TPN) was 10.3 +/- 0.9 days for group G and 9.0 +/- 0.8 days for group G-F. Initial nutritional status and response to TPN were similar for both groups. Immune function was assessed before TPN and after nutritional repletion prior to surgery for each patient. The levels of immunoglobulins, C3, C4, circulating B lymphocytes and T lymphocytes, suppressor T lymphocytes, natural killer cell activity, and monocytes were normal before TPN and after nutritional therapy. However, the total number of T cells and helper T cells were low before TPN and remained so after TPN. In addition, lymphocyte function measured by the lymphocyte blastogenic response to phytohemagglutinin and pokeweed mitogen was depressed prior to TPN and was not improved by either regimen. Neutrophil chemotaxis and bactericidal activity were not affected by either nutritional regimen while neutrophil phagocytosis was enhanced before TPN and remained elevated throughout TPN with either regimen. There were no differences in infection rates during TPN. The addition of Intralipid to the TPN regimen did not alter immune function in these patients who showed depressed cell-mediated immunity before TPN compared with the standard glucose TPN regimen.     

转基因豆油的检测

目的探讨转基因豆油的检测方法。方法采用PCR扩增法,对通常转基因植物共有的外源基因35s启动子和Nos终止子序列进行检测,确定其是否转基因作物。结论在转基因豆油中成功检测到35s启动子和Nos终止子的基因片段。     

Toxicity of a soybean oil emulsion on human lymphocytes and neutrophils

BACKGROUND: The incorporation of lipid emulsions in parenteral diets is a requirement for energy and essential fatty acid supply to critically ill patients. In this study, the toxicity of a lipid emulsion rich (60%) in triacylglycerol of omega-6 polyunsaturated fatty acids on leukocytes from healthy volunteers was investigated. METHODS: Eleven volunteers were recruited, and blood samples were collected before infusion of a soybean oil emulsion, immediately afterwards, and 18 hours later. The cells were studied immediately after isolation and again after 24 hours or 48 hours in culture. The following determinations were made: composition and concentration of fatty acids in plasma, lymphocytes and neutrophils, lymphocyte proliferation, levels of cell viability, DNA fragmentation, phosphatidylserine externalization, mitochondrial depolarization, reactive oxygen species production, and neutral lipid accumulation. RESULTS: Soybean oil emulsion decreased lymphocyte proliferation and provoked neutrophil and lymphocyte apoptosis and necrosis. Evidence is presented herein that soybean oil emulsion is less toxic to neutrophils than to lymphocytes. The mechanism of cell death induced by this oil emulsion was characterized by mitochondrial membrane depolarization and neutral lipid accumulation but did not alter reactive oxygen species production. CONCLUSIONS: Soybean oil emulsion given as a single dose of 500 mL promotes lymphocyte and neutrophil death that may enhance the susceptibility of the patients to infections.     

Catabolism of newly formed triglyceride-rich lipoproteins and serum high density lipoproteins in rats fed soybean phospholipid and soybean oil

Previous research has shown that serum cholesterol and apolipoprotein (apo) A-I were lower and serum apoB was higher in rats fed soybean phospholipid (PL) than in rats fed soybean oil. Secretion of cholesterol and apoA-I, but not apoB, from the liver and intestine was lower in rats fed soybean PL. In the present study catabolism of newly formed triglyceride (TG)-rich lipoproteins, from the liver and intestine, and of serum high density lipoproteins (HDL) were compared in rats fed soybean PL and in rats fed soybean oil. The following results were seen: Feeding of soybean PL was related to more TG and less cholesterol in intestinal lymph chylomicrons (CM) and hepatic very low density lipoproteins (VLDL) than was feeding of soybean oil. A lesser amount of the TG, labeled with [3H]oleate in CM and hepatic VLDL, was incorporated into the adipose tissue and muscle in vivo. The clearance of CM-TG from plasma was higher, but that of VLDL-TG and apoB labeled with [3H]lysine was lower. The catabolism of 125I-labeled HDL from the plasma was lower while hepatic uptake of 125I-labeled HDL, in vivo and in vitro, was higher. These results indicate that soybean PL modifies the catabolism of the respective serum lipoproteins. Therefore, we suggest that changes in both the catabolism and secretion of lipoproteins are responsible for the altered serum lipid and apolipoprotein patterns found in rats fed soybean PL.