ω-3脂肪酸对肝部分切除术后患者炎症反应和免疫功能的影响

目的 探讨ω-3脂肪酸对肝部分切除术后患者炎症反应和免疫功能的影响.方法 肝部分切除患者82例参加本研究,所有患者按随机数表法随机分为两组,术后给予等热量、等氮肠外营养治疗.对照组单纯使用中长链脂肪乳,研究组使用中长链脂肪乳联合ω-3脂肪酸.分别于术前、术后第1、3、7天抽取空腹静脉血,检测肝功能(总蛋白、白蛋白、前白蛋白、谷丙转氨酶、谷草转氨酶)、凝血功能(国际标准化比值)、免疫球蛋白(IgA、IgG、IgM)、CD3、CD4/CD8及外周血白细胞计数等.结果 术后第7天研究组患者血清总蛋白(61.40±5.12)g/L显著高于对照组(58.54±5.53)g/L(P=0.018),研究组谷草转氨酶(32.37±11.92)U/L显著低于对照组(42.50±29.97)U/L(JP=0.048),研究组IgA(2.67±1.01)g/L显著高于对照组(2.15±0.77)g/L(P=0.027),研究组IL-1β(7.88±6.45)pg/ml显著低于对照组(12.98±11.07)pg/ml(P=0.034),研究组IL-2(24.98±20.38)pg/ml显著低于对照组(43.09±20.74)pg/ml(P:0.002).两组患者术后第7天外周血白细胞及凝血功能指标差异无统计学意义.结论 ω-3脂肪酸有助于改善肝部分切除术后患者免疫功能及肝功能,降低炎症反应.

Abstract：

Objective To investigate the effects of ω-3 fatty acids (FA) on inflammatory reaction and immunologic function of patients after hepatectomy. Methods Totally 82 patients were randomized into control group and ω-3 FA group. Both groups received parenteral nutrition (PN) with equal nitrogen and calories. Patients in the control group received medium and long-chain lipid emulsion, and those in the ω-3 FA group received ω-3 FA combined with medium and long-chain lipid emulsion. Liver function test (serum total protein, prealbumin, albumin ,aspartate aminotransferase, alanine aminotransferase) , blood coagulation function (international normalized ratio) , immune globubin (IgA, IgG, and IgM) , CD3 and CD4/CD8 were measured on the first, third, and seventh post-operative day. Results Serum total protein in the ω-3 FA group (61. 40 ±5. 12) g/L] was significantly higher than in the control group (58. 54 ± 5. 53 ) g/L] (P = 0. 018 ) . Aspartate aminotransferase in the ω-3 FA group (32. 37 ± 11. 92) U/L] was significantly lower than in the control group (42. 50 ± 29. 97) U/L] (P = 0. 048). IgA in the ω-3 FA group (2. 67 ± 1. 01) g/L] was significantly higher than in the control group (2. 15 ±0.77) g/L] (P=0.027). IL-1β in the ω-3 FA group (7.88 ±6.45) pg/ml] was significantly lower than in the control group (12. 98 ± 11. 07) pg/ml] (P = 0.034). IL-2 in the ω-3 FA group (24.98±20.38) pg/ml] was significantly lower than the control group (43. 09 ± 20. 74) pg/ml] (P = 0.002). The white blood cell counts and coagulation function were not significantly different between two groups. Conclusion Total PN containing ω-3 FA can effectively improve immunologic function and liver function of patients after hepatectomy.