静脉输注脂肪乳剂对糖尿病病人代谢的影响

目的：观察非胰岛素依赖型糖尿病病人输注脂肪乳剂后糖、脂代谢改变。 方法：３８例ＮＩＤＤＭ病人被随机分为伍用正规胰岛素组及伍用口服磺脲类降糖药组，每天输入１０％脂肪乳剂５００ｍｌ连续５天。 结果：ＦＢＳ、ＨＤＬ、ＡｐｏＡ，在两组均未有改变；血清ＴＧ在口服液组升高（Ｐ〈０．０１），Ｃｈ在两组均显著升高（Ｐ〈０．００１）；加用胰岛素可明显促进肝脏短半衰期蛋白质（ＰＡ、ＴＦ）合成（Ｐ〈０．０５）。 结论：     

肝外梗阻性黄疸术后应用脂肪乳剂对血清脂类的影响

对２０例恶性肝外梗阻性黄疸（梗黄）行胰十二指肠切除的病人，术后第１～７ｄ行ＴＰＮ支持。随机分为两组：Ｉ组（观察组）热量的３５％～４０％由长链脂肪乳剂提供，Ⅱ组（对照组）单纯由葡萄糖供热。两组其它条件相同，于术前及ＴＰＮ后第１，５，７ｄ分别检测血清８种游离脂肪酸（ＦＦＡ），血脂（ＴＧ，Ｔｃｈ）脂蛋白（ＨＤＬ，ＬＤＬ，ＶＬＤＬ）结果：Ｉ组已升高的Ｔ－ＦＦＡ和Ｔ－ＳＦＡ明显下降，已低下的ＥＦＡ下降不明显     

TPN中脂肪乳剂对大鼠血浆和组织脂质过氧化的影响

本实验利用ＴＰＮ大鼠模型观察ＴＰＮ液体中ＬＣＴ、ＭＣＴ／ＬＣＴ，以及不含脂肪乳剂对血浆和组织脂质过氧化的影响。本研究提示过量提供ＰＵＦＡ将增加脂过氧化，ＭＣＴ和ＬＣＴ的物理混合，减少了ＰＵＦＡ供给，降低了脂质过氧化。     

脂肪乳剂对呼吸功能的影响

自Ｓｃｈｕｂｅｒｔｈ和Ｗｒｅｔｌｉｎｄ（１９６１年）成功制成脂肪乳剂以来,脂肪乳（ｆａｔｅｍｕｌｓｉｏｎ,ＥＦ）作为肠外营养中非蛋白热量的来源已在临床广泛应用。ＦＥ为机体提供了能量和必需脂肪酸（ＥＦＡ）,避免了ＥＦＡ的缺乏,促进脂溶性维生素的吸收,并...     

短链脂肪酸对大鼠移植小肠作用的研究

目的：了解短链脂肪酸（ＳＣＦＡ）对大鼠移植小肠萎缩及功能低下是否具有预防作用。方法：近交系Ｗｉｓｔａｒ大鼠行异位全小肠移植后第２天开始给予全肠外营养（ＴＰＮ）至第１０天,对照组（ｎ＝１０）行常规ＴＰＮ支持,ＳＣＦＡ组（ｎ＝１０）行常规ＴＰＮ支持并加用ＳＣＦＡ,观察移植肠形态学及吸收功能。结果：ＳＣＦＡ组移植肠绒毛高度、隐窝深度、粘膜厚度及绒毛面积均明显超过对照组,肠上皮细胞偶见线粒体肿大及部分线粒     

表皮生长因子对全肠外营养大鼠肝脏功能的影响

目的：利用大鼠全肠外营养（ＴＰＮ）模型，探讨表皮生长因子（ＥＧＦ）对ＴＰＮ肝脏功能的影响。 方法：４８只ＳＤ大鼠随机分为对照组、常规ＴＰＮ（ＳＴＤ－ＴＰＮ）组和ＥＧＦ－ＴＰＮ组。实验持续１４天，分别测定血糖、肝功能及血糖，并对肝脏进行组织形态学检查。 结果：ＳＴＤ－ＴＰＮ组血胆固醇、甘油三酯、ＡＫＰ、γ－ＧＴ、总胆红质均明显升高（Ｐ〈０．０１），光镜检查提示有脂肪肝发生，电镜观察发现瘀胆明显；ＥＧ     

Ala-Gln增强机体在全胃肠外营养状态下对失血性休克的耐受性

采用ＳＰＦ大鼠全胃肠外营养（ＴＰＮ）支持和失血性休克创伤模型，以ＴＰＮ、ＴＰＮ液中添加丙氨酰谷氨酰胺（Ａｌａ┐Ｇｌｎ）和经肠饮食（ＥＮ）三种营养方式支持一周后，造成失血性休克，观察机体因营养方式差异而处于不同肠屏障功能状态下对再次打击的耐受性。结果显示，标准ＴＰＮ组与ＥＮ相比，血浆二胺氧化酶（ＤＡＯ）水平明显低下；肠固有层（ＬＰ）淋巴细胞和浆细胞、肠上皮内淋巴细胞（ＩＥＬ）及肠腔细菌分泌型ＩｇＡ（Ｓ┐ＩｇＡ）包被率明显下降；盲肠粘膜菌群Ｅ．ｃｏｌｉ优势增殖，双歧杆菌／大肠杆菌（Ｂ／Ｅ）比值倒置，肠上皮细菌粘附增多；肠道细菌易位率升高；死亡率（４／１２）高。而Ａｌａ┐Ｇｌｎ组因添加肠道必需氨基酸谷氨酰胺（Ｇｌｎ）前体Ａｌａ┐Ｇｌｎ，各参数接近ＥＮ组，肠屏障储备增加，死亡率下降。提示：标准ＴＰＮ由于缺乏肠粘膜必需氨基酸（Ｇｌｎ）和肠道刺激，严重损伤肠屏障功能，失血性休克更加重损害，可能促发脓毒血症和多器官功能不全（ＭＯＤＳ）。对标准ＴＰＮ进行改良，添加肠粘膜保护剂Ａｌａ┐Ｇｌｎ对肠屏障有较好维持作用。这对临床不能经肠道喂养的围手术期病人进行如何更有效的肠外营养支持有一定指导意义     

亚油酸对红细胞膜磷脂脂肪酸组成的作用

亚油酸（１８∶２ｎ６）是必需脂肪酸（ＥＦＡ）。肠外营养（ＰＮ）中应用中链／长链脂肪乳剂（ＭＣＴ／ＬＣＴ）,即中链脂肪乳剂和长链脂肪乳剂各一半物理混合形成的脂肪乳剂,含有ＥＦＡ,以１０％的ＬｉｐｏｆｕｎｄｉｎＭＣＴ／ＬＣＴ为例,１８∶２ｎ６占脂肪酸总量的２６％。为探明１８∶２ｎ６对维持红细胞（ＲＢＣ）膜磷脂脂肪酸组成平衡的意义,我们进行下列研究。　　　１　材　料　与　方　法１．１　动物及分组　　禁食２４ｈ后,体重１９２～２２８ｇ的２４只Ｗｉｓｔａｒ大鼠随机分为三组,每组８只。（１）对照组：右…     

长链脂肪乳剂Intralipid对胆囊胆汁脂质成分的影响

目的：本研究为前瞻性观察短期输注脂肪乳剂对病人胆囊胆汁脂质成分以及胆汁成石性的影响，探讨脂肪乳剂在ＴＰＮ继发胆道疾患中的作用。 方法：３０例胃癌病人被随机分成三组，自术前３天起，对照组常规术前准备，２０％Ｉｎｔｒａｌｉｐｉｄ（ＩＬ）组和１０％ＩＬ组分别予以静脉输注长链脂肪乳剂２０％ＩＬ５００ｍｌ／ｄ和１０％ＩＬ１０００ｍｌ／ｄ。术中采取胆囊胆汁，测胆酸、磷脂和胆固醇，计算胆固醇饱和指数（ＣＳＩ）。     

短链脂肪酸对TPN大鼠小肠粘膜结构及细胞增殖作用的研究

目的 探讨短链脂肪酸（ＳＣＦＡｓ）对ＴＰＮ大鼠小肠粘膜的保护作用,方法 将３０只近交系Ｗｉｓｔｅｒ（ＲＴ１＾Ｋ）大鼠随机分为假手术对照组,常规ＴＰＮ组及ＳＣＦＡｓ－ＴＰＮ组,进行为期１４天实验,结束后观察小肠粘膜的形态学变化和细胞增殖情况,结果 常规ＴＰＮ组大鼠肠粘膜绒毛高度,宽度及隐窝深产正常对照组均有显著减少,其增殖指数也显著降低,ＳＣＦＡｓ－ＴＰＮ组上述指标明显升高,与对照组基本接近,结论     

MCT/LCT emulsion ameliorate liver fat deposition in insulin-treated diabetic rats receiving total parenteral nutrition

This study was designed to investigate the effects of high energy infusion and insulin treatment on plasma and liver lipids in diabetic rats receiving total parenteral nutrition (TPN). Diabetes was induced in rats by streptozotocin. The diabetic rats were assigned to two TPN groups to receive either long chain triglyceride (LCT) or medium chain triglyceride (MCT)/LCT (1:1) as a fat source. The TPN solutions were isonitrogenous, isocaloric and identical in nutrient composition except for the fat emulsion. All rats received the TPN solution at an energy level of 35|kcal/100|g of body weight. The LCT and MCT/LCT groups were further divided into two subgroups, depending on whether they were treated with insulin. The results demonstrated that, between the MCT/LCT and LCT groups, no differences were observed in body weight and nitrogen retention, as well as the concentrations of plasma glucose, nonesterified fatty acids, beta-hydroxybutyrate, and total cholesterol. Diabetic TPN rats without insulin treatment had weight loss and negative nitrogen balance during the experiment. Diabetic TPN rats treated with insulin, however, demonstrated less weight loss and positive nitrogen retention. Insulin treated groups had significantly higher liver fat content than did those without insulin treatment. Furthermore, liver fat content was significantly higher in the LCT group than in the MCT/LCT group among insulin treated TPN rats. These results suggest that compared with the LCT emulsion, infusion of the MCT/LCT emulsion ameliorated liver fat deposition in insulin-treated diabetic rats receiving TPN.     

Effects of medium-chain triglyceride in parenteral nutrition on rats undergoing gastrectomy

This study was designed to investigate the effects of pre-infusion with total parenteral nutrition (TPN) using medium-chain triglyceride (MCT) versus long-chain triglyceride (LCT) emulsion as fat sources on hepatic lipids, inflammatory mediators and antioxidant capacity in rats undergoing gastrectomy. Rats with internal jugular catheter, were divided into two groups and received TPN. TPN supplied 300 kcal/kg/d with 39% of the energy provided as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fat emulsion, which was composed of MCT/LCT (1 : 1) or LCT. After receiving TPN for 5 days, the rats underwent partial gastrectomy and were sacrificed 24 h after surgery. The results of the study demonstrated that the MCL/LCT group had lower hepatic lipids than did the LCT group. No differences in interleukin-1beta, interleukin-6 and tumor necrosis factor-alpha in peritoneal lavage fluid were observed between the two groups. Erythrocyte glutathione peroxidase activity was significantly higher in the LCT group than the MCT/LCT group, although erythrocyte superoxide dismutase activity did not differ significantly between the two groups. These results suggest that infusion with MCT/LCT before an abdominal operation did not have an effect on modulating the production of inflammatory mediators in the location of the injurious stimulus. However, pre-infusion with MCT/LCT have beneficial effect in improving liver lipid metabolism and reducing oxidative stress in rats with gastrectomy.     

Effect of Medium-Chain Triglyceride Emulsion in Total Parenteral Nutrition on Experimental Hepatic Metastasis in the Rat

Background: This study evaluated the effect of total parenteral nutrition (TPN) regimens containing a medium-chain triglyceride (MCT) emulsion on tumor metastasis. Methods: Tumor metastasis development was assessed by the number of metastatic foci on the liver surface in rats inoculated with ACL-15 tumor cells via the portal vein. Rats received one of the following TPN regimens: TPN containing an MCT emulsion (group M), in which tricaprylin emulsion served as the MCT and comprised 50% of nonprotein calories (NPC); TPN containing a long-chain triglyceride (LCT) emulsion (group L), in which soybean oil served as the LCT and comprised 50% of NPC; and TPN without lipid emulsion (group G), in which dextrose comprised 100% of NPC. Results: The number of metastatic foci was greatest in rats receiving TPN containing the MCT emulsion on day 11 after tumor cell inoculation and either 11 days of TPN or 2 days of TPN followed by 9 days standard rat chow. Conclusions: TPN containing MCT emulsion increases liver metastasis early in its administration. (Journal of Parenteral and Enteral Nutrition 21:220–223, 1997)     

含中链甘油三脂的脂肪乳剂有利于胃切除术后大鼠的脂类代谢和抗氧化能力

研究胃切除大鼠于术前接受以中链甘油三酯或长链甘油三酯为脂肪来源的肠外营养对肝内脂类，炎性介质和抗氧化能力的影响。大鼠经颈内静脉插管，分成两组接受肠外营养治疗。肠外营养的能量为30kcal/kg/d， 脂肪占能量的39％。除了脂肪乳剂外所有肠外营养制剂都是等氮的并含有相同的营养成分，脂肪乳剂的成分中链／长链（1：1）或长链脂肪乳剂。大鼠于接受肠外营养5天后经部分胃切除术，于术后24小时处死。研究结果显示，中逻／长链组肝内脂肪少于长链组。提示中链／长链脂肪乳剂能改善肝脏脂类代谢。两组大鼠的腹腔灌洗液（PLF）和血液中白介素－1β（Ⅱ-1β），白介素－6（Ⅱ－6）和肿瘤坏死因子α（TNF－α）无显差别，说明术前输入中链／长链脂肪乳剂对调节大鼠循环血液中的炎性介质和手术刺激没有影响。长链脂肪乳剂组的红细胞谷胱甘肽超氧化物酶（GSHPx)的活力明显高于输入中链／长链脂肪乳剂组，但红细胞超氧化物歧化酶（SOD）的活力在两组之间无显性差别。这些结果说明，腹部手术前输入中链／长链脂肪乳剂能改善脂类代谢和减少氧化物的刺激。结论：推荐对准备行胃手术的肠外营养支持的病人使用中链／长链脂肪乳剂。     

Effect of various lipid emulsions on total parenteral nutrition-induced hepatosteatosis in rats

The effect of various lipid emulsions on the development of fatty liver during total parenteral nutrition (TPN) was investigated in rats given TPN for 7 days. Medium-chain triglycerides (MCT), long-chain triglycerides (LCT), chemically defined triglycerides (CDT; structured lipid with a high purity of 94.3%), and a mixture of MCT and LCT (MIX) were prepared as the lipid emulsions. TPN provided 350 kcal/kg/day, with a nonprotein calorie/nitrogen ratio of 160. The TPN-1 group received 10% nonprotein calories and the TPN-2 group received 30% nonprotein calories. MCT TPN was found to have some disadvantages, especially with regard to nitrogen balance and plasma albumin levels. Total cholesterol and phospholipids tended to be high in the MCT TPN group. The hepatic lipid content was higher in the lipid-free TPN and the MCT TPN groups, and lower in the CDT and LCT TPN groups. Histologically, the livers of the MIX, CDT, and LCT TPN groups showed less fatty change than those of the FREE and MCT groups.     

The Henry M. Vars Award. The effect of lipid emulsions on reticuloendothelial system function in the injured animal

Use of intravenous lipid emulsions in trauma and sepsis still remains controversial. In order to examine the impact lipid emulsions have on host defense against bacterial infection during total parenteral nutrition (TPN), 56 male Sprague-Dawley rats underwent jugular cannulation and were randomly divided into three groups, each receiving one of three TPN regimens. All regimens delivered approximately 250 kcal/kg X body weight/day, of which 12.5 g were as amino acids. Group 1 received 100% of the nonprotein calories as glucose (AA + G). Group 2 was given 50% of the nonprotein calories as a longchain triglyceride emulsion (100% LCT). Group 3 received 50% of nonprotein calories as a mixed lipid system, composed of medium- and long-chain triglycerides (75% MCT/25% LCT). After 24 hr on intravenous nutrition, all animals received bilateral septic femur fractures and were continued on TPN for 3 days. On the last day, the level of bacteremia and the in vivo response to an intravenous challenge of 59Fe-labeled Escherichia coli were examined. Three days following the septic injury, animals given MCT as part of their lipid calories were not bacteremic, whereas the other groups had greater than 10(2) cfu/ml of blood. Animals receiving TPN with MCT sequestered a greater percentage of exogenously administered bacteria in the liver and sequestered less in the lung compared to animals given 100% LCT (p less than 0.05). From these data, we conclude that parenteral nutrition formulas where LCT has been partially replaced with MCT may better support host bactericidal capacity than similar regimens comprised of LCT as the sole lipid source.     

Parenteral infusion of long- and medium-chain triglycerides and reticuloendothelial system function in man

Previous study demonstrated that patients who received total parenteral nutrition (TPN) with standard intermittent infusion of long chain triglyceride (LCT) at 0.13 g kg-1hr-1 over 10 hr for each of three days showed a significant decline in 99Tc-sulfur colloid (TSC) clearance rate by the reticuloendothelial system (RES). The present studies evaluated eight patients who received the same total lipid dose of LCT infused continuously as in a three-in-one admixture, and another nine patients receiving the same amount of fat as a medium chain triglyceride (MCT)/LCT (75%/25%) emulsion intermittently over 10 hr at 0.13 g kg-1hr-1 for three consecutive days. Patients were given continuous total parenteral nutrition (TPN) comprised of protein, 1.5 g kg-1day-1, and dextrose, 4.5 g kg-1day-1. RES function was examined by measuring the clearance rates of intravenously injected TSC while receiving TPN containing only protein and dextrose, and again after three days of fat infusion. Mean (+/- SEM) clearance rate constants before and after continuous LCT infusion were 0.38 +/- 0.09 and 0.41 +/- 0.08 min-1, respectively, while those before and after intermittent MCT/LCT infusion were 0.50 +/- 0.18 and 0.73 +/- 0.24 min-1, respectively. In contrast to intermittent LCT infusion, the administration of continuous LCT or an intermittent MCT/LCT mixture does not impair TSC clearance by the RES. These findings suggest that condensing the daily period of LCT infusion at standard dosage may exceed the rate of metabolic utilization, resulting in increased fat removal and diminished TSC uptake by the RES.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lipid and lipid-free total parenteral nutrition: differential effects on macrophage phagocytosis in rats

Lipid emulsions provided with total parenteral nutrition (TPN) have been associated with mononuclear phagocytic system functional changes. The aim of the present investigation was to assess the influence of TPN with added lipid emulsions on macrophage (M phi) phagocytosis. Wistar rats (n = 70) with external jugular vein cannulation were randomized into seven groups. The rats received an oral diet or six different isocaloric (1.16 kcal/mL), isonitrogenous (1.5 g/mL), and isolipidic (30% non-protein calories) TPN regimens: (a) an oral diet with intravenous infusion of saline (OS); (b) non-lipid TPN (glucose); (c) TPN with 10% long chain triacylglycerol emulsions (LCT); (d) TPN with 90% LCT and 10% fish oil (FO) emulsion; (e) TPN with 50% LCT and 50% FO; (f) TPN with 10% lipid emulsion with 50% medium chain triacylglycerol (MCT) and 50% LCT; and (g) TPN with 45% MCT, 45% LCT, and 10% FO. After 96 h of TPN or saline infusion, colloidal carbon (Pelikan, Germany) was injected intravenously at 1.0 mL/kg body weight, and the rats were killed after 3 h. Liver, spleen, and lung were weighed and prepared by immunohistochemistry analyses with the HAM-56 anti-M phi antibody. Under light microscopy, the total M phi number (MT) and the colloidal carbon phagocytic M phi number (MP) were established, and the phagocytic index was calculated as MP/MT x 100. There were no statistical (P < 0.05) differences in liver, spleen, or lung weights among the seven groups in comparison with the OS group. Non-lipid TPN inhibited spleen and lung M phi phagocytosis when compared with the OS and lipid-TPN groups. Lipid TPN supplemented with fish oil emulsion increased total liver and lung M phi number and phagocytosis. These results indicate that TPN supplemented with fish oil increases M phi phagocytosis in rats.     

Significance of administration of fat emulsion: hepatic changes in infant rats receiving total parenteral nutrition with and without fat

Total parenteral nutrition (TPN) is associated with cholestasis and hepatic steatosis, which can be lethal in infants who cannot be fed orally. The present animal study focused on the metabolic complications in the liver that may occur due to the excessive administration of fat-free TPN. Thirty infant (3-week-old) male SD rats weighing 60-70 g were randomly allocated to five groups (n = 6): the OD group received an oral diet, the FT group received an oral diet and was fasted overnight on the last day of experiment before sacrifice, the 0% fat group received TPN without fat, the 20% fat group received TPN with 20% of calories from fat emulsion, and the 40% fat group received TPN with 40% of calories from fat emulsion. All TPN regimens were isocaloric, isonitrogenic, and administered for 4 days. In the 0% fat group, plasma levels of liver enzymes were significantly higher than in the other groups. Pathological examination showed hepatomegaly and severe fatty changes without cholestasis in the 0% fat group. The results of this study in infant rats indicate the importance of including fat in the TPN regimen in order to prevent the abnormal hepatic changes associated with the excessive administration of fat-free TPN.     

Effect of structured lipids as energy substrate after hepatectomy in rats with streptozocin-induced diabetes.

The suitability of energy substrates for use by the remnant liver after 70% hepatectomy was studied in relation to the hepatic energy status in diabetic rats. Rats with streptozocin-induced diabetes underwent 70% hepatectomy and were divided into five groups receiving total parenteral nutrition (TPN) for 24 h. One group received standard TPN without fat, and four groups respectively received standard TPN with long-chain triglycerides (LCTs), medium-chain triglycerides (MCTs), mixed triglycerides (MIX), or structured lipids (SLs) as a 10% lipid emulsion. The latter groups received 60% of nonprotein calories per day with fat emulsion (LCT, MCT, MIX, or SL), and the remaining 40% with glucose. The group that received 100% of nonprotein calories per day with glucose was defined as the TPN group. All rats in the TPN group died from nonketotic hyperosmolarity within 24 h. The blood ketone body ratio (acetoacetate/beta-hydroxybutyrate), the energy charge level of the remnant liver, and the cumulative excretion of 14CO2 in expired breath during 6 h after [14C]glucose administration were all significantly higher in the SL group than in the other groups 24 h after hepatectomy. These findings suggest that SL may be a superior energy substrate to other triglyceride preparations during the immediate posthepatectomy phase in diabetic patients.