TPN在重症胰腺炎中的应用

我院自1994～1996年以来，对30例重症胰腺炎患者手术后行全胃肠外营养（TPN）支持疗法，效果满意，现报告如下。临床资料急性重症胰腺炎病人30例，男16例，女14例，年龄26～42岁，均经手术治疗（坏死组织切除，胰周多管道引流，术后持续腹腔冲洗），并于术后第2天开始持续应用TPN行营养支持，时间20～40天。TPN采用两组配方，A组（17人）为强化TPN配方，即降低葡萄糖含量，增加脂肪乳剂供能，提高氦含量，并于术后4周内每日或隔日给予血浆200～40Oml或20％白蛋白50～100ml。B组（13入），应用一般胃肠手术后的TPN配方。两组病人均对…     

复方丹参对高脂大鼠模型骨形态计量学参数的影响

背景：复方丹参对抗泼尼松性大鼠的骨丢失具有抑制骨吸收作用,但对高脂血症所致的骨质疏松症效果如何未见报道。目的：通过骨形态计量学观察复方丹参对大鼠胫骨和腰椎骨丢失的防治作用。方法：用脂肪乳剂建立高脂血症骨丢失大鼠模型,30只SD大鼠随机数字表法分为3组,正常对照组、高脂乳剂组、复方丹参组,分别给予生理盐水、高脂乳剂、高脂乳剂和复方丹参,连续16周。结果与结论：与高脂乳剂组相比,复方丹参可使高脂大鼠胆固醇明显降低和高密度脂蛋白胆固醇明显升高,可以有效改善高脂乳剂导致的脂质代谢紊乱。复方丹参组的骨小梁面积百分数、骨小梁数量、成骨细胞贴壁长度百分率均增加（P〈0.05）,而骨小梁分离度、每毫米破骨细胞数、破骨细胞贴壁长度百分率均减少（P〈0.01）,反映骨形成及骨矿化的指标变化不明显;胫骨中段的皮质骨面积百分数增加（P〈0.01）,骨髓腔面积百分数减少（P〈0.01）,骨内外膜的形成和矿化均无明显变化;腰椎松质骨的骨小梁面积百分数、骨小梁数量、骨小梁宽度增加（P〈0.05）、而骨小梁分离度减少（P〈0.01）。提示长期高脂乳剂灌胃会导致大鼠骨量丢失,复方丹参能有效对抗高脂大鼠胫骨上段、中段骨、第5腰椎的骨丢失。     

银杏叶提取物新配方对高脂血症大鼠的干预效应

背景：调脂治疗在冠状动脉粥样硬化性心脏病的一、二级预防中的作用已得到充分肯定，银杏叶提取物具有一定的降脂作用。 目的：建立高脂大鼠模型，观察银杏叶提取物新配方（由银杏总黄酮和银杳内酯组成）对高脂血症大鼠血脂水平的干预及肝脏脂肪变性程度。 设计：随机对照观察。 单位：复旦大学附属金山医院心内科，苏州大学药学系，苏州中药研究所。 材料：选取清洁级SD大鼠60只。适应性饲养1周后。随机分成6组：正常对照组、高脂模型组、力平脂25mg／（kg&;#183;d）组、银杏叶提取物新配方20mg／（kg&;#183;d）组、银杳叶提取物新配方40mg／（kg&;#183;d）组、银杏叶提取物新配方80mg／（kg&;#183;d）组，10只／组。方法：力平脂25mg／（kg&;#183;d）组、银杏叶提取物新配方20mg／（kg&;#183;d）组、银杏叶提取物新配方40mg／（kg&;#183;d）组、银杏叶提取物新配方80mg／（kg&;#183;d）组均以10mL／kg体积于每天上午9：00-10：00灌服给药，正常对照组和高脂模型组给予等体积的蒸馏水灌服。除正常对照组外，其余各组大鼠于每天下午1-00-2：00同时以10mL／kg体积灌服脂肪乳剂，连续28d。第29天各组分别测定血清总胆固醇、三酰甘油和高密度脂蛋白胆固醇、血清载脂蛋白AI、血清载脂蛋白B。同时取出各组大鼠肝脏进行病理检查，观察肝脏脂肪变性程度。主要观察指标：造模后各组大鼠的血脂情况以及肝脏脂肪变性程度。 结果：实验选用大鼠60只。均进入结果分析。①造模后各组大鼠血脂情况的比较：高脂模型组血清总胆固醇、低密度脂蛋白胆固醇明显增加，高密度脂蛋白胆固醇降低，与正常对照组比较差异显著（P〈0．01），但血清三酰甘油仅有轻度升高（P〉0．05）；银杏叶提取物新配方20～80mg／（kg&;#183;d）组均可不同程度地抑制大鼠高脂血症的形成。表现为血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇均明显降低（P〈0．05或0．01），并有一定升高岛密度脂蛋白胆固醇、血清载脂蛋白AI及降低血清载脂蛋白B的作用。其中银杏叶提取物新配方80mg／（kg&;#183;d）组最为显著（P〈0．05）。②造模后各组大鼠肝脏脂肪变性程度的比较：高脂模型组大鼠的肝病理检查可见弥漫性脂肪空泡；银杏叶提取物新配方40，80mg／（kg&;#183;d）组大鼠肝脂肪变性程度有一定的减轻，尤以银杏叶提取物新配方80mg／（kg&;#183;d）组效果明显。 结论：提示银杏叶提取物新配方可有效地纠正高脂血症的脂质代谢，对高脂饮食所致的高脂血症具有良好的预防作用。     

结肠癌行微栓塞化疗的可行性与安全性

目的：探讨结肠癌行微栓塞化疗的可行性与安全性。方法：将成年杂种犬16只分为：（1）对照组（犬6只）,又分为直径（φ)30～60um医用活性炭微粒（CH44）组（A组）及φ10～20um碘化油乳剂组（B组）,各3只。（2）实验组（犬10只）,分为单严阵以待同栓塞组（C组）和微栓塞化疗组（D组）栓子均为CH44,φ10～20um,化疗药物为FAM）,各5只。经腹行肠系膜下动脉插管,推注不同栓子,观察犬术后反应,于不同时间取结肠壁作光镜及透射电镜检查。并作尸体解剖。结果：对照组栓塞段结肠完全坏死。实验组仅结肠粘膜及粘膜下层出现一过性变性,偶有微小灶状坏死。微栓塞化疗组反应强于单纯微栓塞组。损伤2周后完全修复。肝、肺、肾、淋巴结等组织中有微栓子存在。结论：正常犬结肠可耐受特定栓子的一过性微栓塞化疗。     

壳聚糖、桑叶与决明子提取物对大鼠体脂、血脂与血糖的影响

目的：探讨壳聚糖、桑叶提取物及河原决明子提取物单用和联用对大鼠体质量、内脏脂肪质量以及降低血脂、血糖水平的影响.方法：实验于2003-10/11在大连医科大学中日合作医药科学研究所完成.选择4周龄雄性SD大鼠48只,随机分为6组,壳聚糖组、桑叶提取物组、决明子提取物组、混合组、高脂饲料对照组和基础饲料对照组各8只.基础饲料对照组大鼠喂饲基础饲料,其他组大鼠均喂饲高脂饲料膳食（77.5%基础饲料、2%胆固醇、0.5%胆酸钠、15%猪油和5%蛋黄）.壳聚糖组、桑叶提取物组、决明子提取物组及混合组大鼠经灌胃分别给予壳聚糖100 mg/kg、桑叶提取物25 mg/kg、决明子提取物100 mg/kg及壳聚糖＋桑叶提取物＋河原决明提取物225 mg（100mg壳聚糖＋25 mg桑叶提取物＋100 mg决明子提取物）/kg.高脂饲料对照组和基础饲料对照组灌胃给予蒸馏水,灌胃容积为20 mL/kg,1次/d.各组大鼠均喂饲4周,每周称量1次体质量.在第4周末,检测粪便中脂肪含量采用乙醚提取法定量,测定血清三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、葡萄糖、丙氨酸转氨酶、天冬氨酸转氨酶、y-谷氨酰转肽酶、血尿素氮及肌酐均采用酶促方法定量.血清游离脂肪酸及丙二醛分别采用铜试剂法和硫代巴比妥酸反应法.乙醚麻醉后剖取肝、肾、心脏及生殖器周围脂肪组织,并称重.结果：48只大鼠全部进入结果分析,无脱失.①各组大鼠体质量及增重：喂饲4周后,壳聚糖组、桑叶提取物组、决明子提取物组及混合组大鼠体质量及其增重明显低于高脂饲料对照组（P＜0.05）.②各组大鼠脏器及生殖器周围脂肪组织质量及相对质量：喂饲4周后,各受试物单用组大鼠肝脏质量及生殖器周围脂肪质量明显低于高脂饲料对照组（P＜0.01）;混合组大鼠肝脏质量明显低于桑叶提取物组（P＜0.05）,而生殖器周围脂肪质量明显低于壳聚糖组及决明子提取物组（P＜0.05）.③各组大鼠血液生化指标：喂饲4周后,各受试物单用组及混合组大鼠三酰甘油、胆固醇、低密度脂蛋白胆固醇及血糖浓度明显低于高脂饲料对照组（P＜0.05～0.01）;混合组大鼠三酰甘油浓度显著低于单用组（P＜0.05）,而混合组胆固醇浓度明显低于壳聚糖及桑叶提取物组（P＜0.01）,低密度脂蛋白胆固醇浓度明显低于桑叶提取物组（P＜0.05）.④各组大鼠粪便中脂肪质量：喂饲4周后,壳聚糖组、桑叶提取物组、决明子提取物组、混合组及高脂饲料对照组大鼠粪便中脂肪含量均明显高于基础饲料对照组（P＜0.01）.结论：壳聚糖、桑叶提取物或决明子提取物均可减轻大鼠的体质量与内脏脂肪质量,并可降低血脂与血糖,但联合应用的效果更好.     

决明子蒽醌在细胞内胆固醇合成中的作用

背景：有关决明子降脂的有效化学成分及作用途径作者进行资料查询时尚未找到明确报道。目的：观察决明子蒽醌类化合物对实验性高脂血症大鼠血脂水平及细胞内源性总胆固醇合成的影响，推断决明子降脂的有效成分及作用途径。设计、时间及地点：随机对照动物实验，于2003—09／2004-05在华南师范大学生命科学学院完成动物饲养及实验，在生物技术研究所完成尾静脉取血、血脂测定、细胞培养及存活率测定。材料：选用SD雄性成年大鼠45只，均灌胃脂肪乳剂建立高脂血症动物模型。决明子购于广州药房，由华南植物研究所鉴定；蒽醌由华南师范大学生物技术研究所制备。方法：将45只SD雄性大鼠按随机数字表法分为3组（n=15）：即对照组、决明子葸醌80mg／kg组和决明子蒽醌20mg／kg组。造模2d后各组动物每天上午继续灌胃脂肪乳剂1次；下午按实验分组灌胃相应剂量的药物，对照组灌胃相同剂量的生理盐水，1次/d，连续20d。主要观察指标：应用两性霉素B细胞模型法检测决明子蒽醌在中国仓鼠卵细胞内源性胆固醇合成中的作用。应用酶终点法测定各组大鼠血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇水平；采用四甲基偶氮唑蓝法以分光光度测定中国仓鼠卵细胞的存活率（A570）。结果：①决明子葸醌能明显降低高脂血症大鼠血清总胆固醇、三酰甘油及低密度脂蛋白胆固醇水平，提高高密度脂蛋白胆固醇水平，呈明显的量一效关系。②决明子蒽醌能提高中国仓鼠卵细胞的存活率。结论：决明子葸醌具有降血脂作用，是决明子降脂的主要有效部位；抑制细胞内胆固醇的合成可能是决明子葸醌降脂的作用途径之一。     

早期肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的探讨早期肠内营养对重症急性胰腺炎（SAP）大鼠肠道屏障功能的影响。方法将48只SD大鼠随机分为SAP模型对照组（Con组）、肠外营养组（TPN组）、造模后24h行肠内营养组（EN-2组）和造模后12h行肠内营养组（EN-1组）。从胰尾部开始被膜下多点缓慢均匀注入3．8％牛磺胆酸钠1mL建立SAP模型,于第3、6天2个时间点处死大鼠,取血检测外周血清二胺氧化酶（DAO）、肿瘤坏死因子（TNF-a）和白细胞介素10（IL-10）的变化;取空肠测量黏膜厚度及绒毛高度。结果建模第3、6天,血清TNF-a、IL-10、DAO水平EN-1、EN-2组较Con组明显降低（P〈0．05）;TPN组比Con组虽有下降趋势,但无显著性差异（P〉0．05）;EN-1、EN-2组比TPN组均明显下降（P〈0．05）。血清DAO测定EN-2组与EN-1组相比,差异有显著性意义（P〈0．05）。病理检查显示：EN-2组和EN-1组肠黏膜厚度和绒毛高度均较Con组、TPN组明显增高（P〈0．05）;EN-1组与EN-2组相比,也显著改善了肠黏膜厚度和绒毛高度（P〈0．05）。结论早期肠内营养可保护SAP大鼠肠道屏障及减轻炎症反应。     

谷氨酰胺对肝门阻断后肝脏损伤影响的实验研究

目的：探讨谷氨酰胺（Gln）对肝门阻断后肝脏损伤的影响及其意义。方法：雄性Wistar大鼠,随机分为3组：假手术组（1组）、对照组（2组）和实验组（3组）。采用Pringle′s法进行肝门阻断,持续35 min,肝门阻断前3组大鼠腹腔注射Gln。分别于肝门阻断前及再灌注后2、4、24 h,每组各选取10只大鼠,测定血清ALT、AST、LDH含量;肝组织谷胱甘肽（GSH）、超氧化物歧化酶（SOD）、丙二醛（MDA）的含量,检测血清TNF-α及门静脉血浆内毒素水平。结果：与对照组相比,再灌注后实验组肝组织中MDA含量下降（P〈0.05）,而GSH及SOD水平增高（P〈0.05）;血清ALT、AST、LDH含量,TNF-α及内毒素水平均明显降低（P〈0.05）。结论：Gln能有效地减轻肝门阻断所致的肝缺血再灌注损伤,可能与Gln抑制内毒素易位及炎症因子释放有关。     

高密度脂蛋白对严重烧伤大鼠肝组织保护的组织学观察

目的：探讨高密度脂蛋白（HDL）对严重烧伤大鼠肝脏的保护作用。方法：制作大鼠30％体表Ⅲ度烫伤模型，观察正常对照组（不作任何处理），烧伤组（烫伤后30min补充平衡溶液）及实验组（烫伤后立即静脉注入HDL）。伤后12、24、48、72h4个时间点的肝组织学变化和细胞间粘附分子1（ICAml）的表达。结果：（1）组织学观察：烫伤后各组大鼠肝细胞均有不同程度损伤，其中以烧伤组伤后24h最重，肝窦扩张充血，窦内炎细胞浸润，肝细胞变性，点灶性坏死，实验组24h肝组织学改变与烧伤组比较上述损伤明显改善。正常对照组肝组织结构基本正常。（2）ICAm-1免疫组化检测：正常对照组无表达，烧伤组与实验组ICAm-1平均表达率分别为81．6％（49／60）及36．6％（22／60），两组24h时段的表达率分别为86．6％（13／15）及20％（3／15），烧伤组表达强度明显高于实验组（P〈O．01），而两组各其他时段表达强度差异无显著性（P〉0．05）。结论：严重烧伤大鼠早期应用HDL对抑制肝细胞中ICAm-1的表达，减少肝细胞免疫损伤有良好的效果。     

调脂护肝方对高脂饲养所致脂肪肝大鼠生化指标的影响

目的观察调脂护肝方对高脂饲食脂肪肝大鼠的干预效应，探讨其药效学机制。方法将雄性SD大鼠64只正常喂养1周后，随机分为正常组12只饲基础饲料，实验组52只给予高脂饲料饲食（含胆固醇2％，猪油10％，基础饲料88％），13周末随机抽取正常组2只、高脂饲养8只，验证高脂饲养大鼠脂肪肝形成。剩余44只随机分为4组即病理模型组、东宝甘泰组、羊栖菜组、调脂护肝方组，每组11只。在继续饲高脂饲料外，分别给予东宝甘泰，按0．5g／（kg·d）（用蒸馏水配成0．05g/ml的混悬液），羊栖菜煎剂按10ml／（kg·d）（10ml含羊栖菜生药20g），调脂护肝方按10ml／（kg·d）（由羊栖菜、丹参、制大黄、葛根、泽泻、茯苓=3：2：1：1：1：1），共8周。第21周末称重，处死动物，取肝脏，计算肝脂数（肝重／体重×100％），抽血，并检测：血清总胆固醇（TC）、甘油三酯（TG）、高密度脂白蛋白-胆固醇（HLD-C）、血清丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、血清超氧化物歧化酶（SOD）、丙二醛（MDA）。结果与病理模型组、东宝甘泰组比较调脂护肝方组大鼠体重、肝指数血清TC值、TG值均降低，HLD-C值增高，血清ALT、AST、MDA值均较低，SOD值较高（各组比较P〈0．01）。结论调脂护肝方干预非酒精性脂肪肝的药效机制为：降低体重与肝指数，调整脂质代谢，改善肝功能，抗脂质过氧化。     

Effect of medium-chain triglycerides (MCT) as an energy substrate after hepatectomy in rats with streptozotocin-induced diabetes

The suitability of energy substrates used by the remnant liver after a 70% partial hepatectomy was studied in relation to the hepatic energy status in diabetic rats. Rats with streptozotocin-induced diabetes mellitus underwent 70% hepatectomy, and were divided into three groups receiving total parenteral nutrition (TPN) for 24h. One group received standard TPN without fat, while two other groups received standard TPN with medium-chain triglycerides (MCTs) or long-chain triglycerides (LCTs) as a 10% lipid emulsion. All rats of the TPN group without fat died within 24h. Blood ketone body ratios (aceto-acetate/beta-hydroxybutyrate), energy charge levels of the remnant liver, and cumulative amounts of 14CO2 in the expired breath during the 6h following 14C-labeled fat emulsion administration (MCT or LCT) were all significantly higher in the MCT group than in the LCT group 24h after hepatectomy. These findings suggest that medium-chain fatty acids (MCFAs) as an energy substrate are superior to long-chain fatty acids (LCFAs) during the immediate posthepatectomy phase in diabetics.     

Pathogenesis of hepatic steatosis in the parenterally fed rat.

Hepatic steatosis frequently complicates total parenteral nutrition (TPN). Some of the mechanisms responsible were examined in rats receiving calories as dextrose (CHO-TPN) or dextrose plus lipid emulsion (Lipid-TPN). Hepatic triglyceride content increased approximately threefold after CHO-TPN and twofold after Lipid-TPN (P less than 0.02). Hepatic triglyceride fatty acid composition reflected endogenous synthesis. Hepatic acetyl-Coenzyme A carboxylase specific activity increased fourfold after CHO-TPN and twofold after Lipid-TPN, and it correlated positively with hepatic lipid content (r = 0.82). The activities of the microsomal enzymes of complex lipid synthesis were unchanged in the TPN groups. Both TPN regimens suppressed hepatic triglyceride secretion, measured by the rise in plasma triglyceride and the incorporation of [14C]palmitic acid into plasma triglyceride after intravenous Triton. Hepatic triglyceride secretion correlated negatively with total hepatic lipid content (r = -0.89). CHO-TPN increased the uptake of a radiolabeled triglyceride emulsion and increased hepatic lipase activity, whereas Lipid-TPN decreased both. Both adipose and cardiac lipase were higher for Lipid-TPN animals than for CHO-TPN or control animals. Hepatic 14C-triglyceride content was increased in both TPN groups as compared with controls after the injection of 1-[14C]-palmitic acid. This increment was proportional to the decreased hepatic secretion. Triglyceride fatty acid oxidation was significantly suppressed by CHO-TPN, less so by Lipid-TPN. Free fatty acid oxidation was suppressed only by CHO-TPN. The results suggest that the steatosis induced by TPN in rats was due to enhanced hepatic synthesis of fatty acid and reduced triglyceride secretion. Reduced hepatic triglyceride uptake, enhanced fatty acid oxidation, and enhanced peripheral tissue plasma triglyceride lipolysis when CHO-TPN is supplemented with lipid may modulate the accumulation of hepatic triglyceride and, along with reduced synthesis of fatty acid, lead to a lower hepatic triglyceride content.     

超声诊断弥漫性胰腺脂肪浸润的临床意义

目的探讨超声诊断弥漫性胰腺脂肪浸润的临床意义,分析弥漫性脂肪浸润与血脂、血糖浓度的关系。 方法选取2016年6月~11月在扬州大学附属医院进行健康体检的64 155位受检者,超声诊断为弥漫性胰腺脂肪浸润的共1030例,随机选取同期无胰腺脂肪浸润的4229例受检者作为无胰腺脂肪浸润组,整理所选受检者的体检报告资料,通过χ²检验分析弥漫性胰腺脂肪浸润组与无胰腺脂肪浸润组间高血脂、高血糖发生率的差异,并采用独立样本t检验探讨弥漫性胰腺脂肪浸润与血脂、血糖浓度的关系。 结果弥漫性胰腺脂肪浸润组空腹高血糖、高胆固醇、高甘油三酯的发生率分别为23.7%、14.1%及62.1%,无胰腺脂肪浸润组空腹高血糖、高胆固醇、高甘油三酯的发生率分别为11.1%、10.2%及34.5%,弥漫性胰腺脂肪浸润组空腹高血糖、高胆固醇、高甘油三酯的发生率显著高于无胰腺脂肪浸润组,差异均有统计学意义（χ²=112.74、13.00、259.36,P均<0.001）。弥漫性胰腺脂肪浸润组空腹血糖、胆固醇、甘油三酯的平均浓度分别为（5.86±1.91）mmol/L、（4.72±0.94）mmol/L及（2.45±2.03）mmol/L;无胰腺脂肪浸润组空腹血糖、胆固醇、甘油三酯的平均浓度分别为（5.30±1.31）mmol/L、（4.54±0.90）mmol/L及（1.74±1.80）mmol/L,弥漫性胰腺脂肪浸润组空腹血糖、胆固醇及甘油三酯浓度显著高于无胰腺脂肪浸润组,差异均有统计学意义（t=11.12、5.48、11.74,P均<0.001）。 结论超声诊断弥漫性胰腺脂肪浸润对于提示无症状的高血脂、高血糖有重要的临床价值,可为临床早期进行干预治疗提供依据。     

鱼油脂肪乳与中长链脂肪乳对胃肠道肿瘤患者肠外营养术后细胞免疫及炎症反应的影响

【目的】探讨鱼油脂肪乳与中长链脂肪乳肠外营养对胃肠道肿瘤患者术后细胞免疫及炎症反应的影响。【方法】选取本院2013年10月至2014年10月收治的胃肠道肿瘤术后行肠外营养患者70例,随机分为对照组和观察组,每组各35例。两组患者均接受等氮、等热量的全肠外营养支持：对照组患者术后24 h内、7 d补充中长链脂肪乳;观察组患者术后24 h内、7 d补充中长链脂肪乳联合鱼油脂肪乳。检测两组患者术后d1及d8静脉血中T淋巴细胞亚群（CD3、CD4、CD8细胞）百分比及CD4／CD8比值、单核细胞数目、单核细胞人类白细胞DR抗原（HLA‐DR）表达百分比、白细胞介素‐1β（IL‐1β）、白细胞介素‐6（IL‐6）以及C反应蛋白（C reactive protein ,CRP）含量,并统计两组患者术后并发症的发生情况。【结果】术后d1,两组患者细胞免疫功能指标及炎症反应指标相比较,差异无统计学意义（ P ＞00．5）;术后d8,观察组患者CD3、CD4细胞百分比、CD4／CD8比值、单核细胞数目和 HLA‐DR表达百分比显著高于对照组,差异具有统计学意义（ P ＜00．5）;观察组患者IL‐1β、IL‐6以及CRP含量均显著低于对照组,差异具有统计学意义（ P ＜00．5）;观察组并发症的发生率显著低于对照组,差异具有统计学意义（ P ＜00．5）。【结论】胃肠道肿瘤患者术后以鱼油脂肪乳营养支持能够提高患者细胞免疫功能,减轻患者术后的炎症反应,降低术后并发症的发生率,值得临床推广应用。     

Use of 20% fat emulsion in total parenteral nutrition

Sixteen elderly postoperative patients were randomized in a crossover study comparing isocaloric volumes of 20% and 10% fat emulsions used for total parenteral nutrition (TPN). The caloric intake was maintained constant during the two 7-day periods of each infusion. The indices measured after each period were total volume of fluid administered, change in body weight, hematocrit, serum sodium, creatinine, albumin, blood urea nitrogen, glucose, inorganic phosphate, and cholesterol. The total volume of 10% isocaloric nutrient solution was significantly (p less than .05) greater than that of the 20% solution. A rise in body weight and a fall in serum indices of hydration status were observed; five patients developed clinical signs of overhydration while on the 10% solution. These changes did not occur with the 20% solution. Thus, isocaloric substitution of a 20% fat emulsion for a 10% fat emulsion with TPN prevented overhydration and hemodilution without compromising nutrient intake.     

Fatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients

Objective: To determine the effects on platelet membrane fatty acid composition following administration of two different fat emulsions. Design: Prospective, randomized, double-blind study. Setting: Intensive care unit in a university-affiliated hospital. Patients: 12 adult critically ill patients in need of total parenteral nutrition. Interventions: Patients were treated with total parenteral nutrition (TPN) for 7 days, receiving for fat intake either a long-chain triglyceride (20 % LCT) emulsion (group 1, n = 6) or a medium-chain triglyceride-LCT (20 % MCT/LCT) emulsion (group 2, n = 6). Measurements and results: High-performance liquid chromatography of membrane fatty acids was carried out before and after 7 days of TPN. In the LCT group, an increase in C18:2n-6 and a decrease in caprylic acid and docosahexaenoic acid, which resulted in a decreased ratio of n-3/n-6 fatty acid content, was observed. In the MCT/LCT group, a reduced percentage of palmitoleic acid and arachidonic acid was shown. Conclusions: The observed changes in fatty acid composition are in agreement with the lipid composition of the fat emulsions used. Because the C18:2n-6/C18:3n-3 ratio in both emulsions is close (approximately 9.0), the observed changes in the fatty acid composition of platelets may not be relevant for platelet function. Received: 22 June 1998 Accepted: 20 January 1999     

Essential fatty acid deficiency and neutrophil function: studies of lipid-free total parenteral nutrition in monkeys

Linoleic acid (18:2 omega 6), the obligate precursor of arachidonic acid (20:4 omega 6), is an essential nutrient for humans and other mammals. Because arachidonic acid release and metabolism are components of neutrophil activation by certain stimuli, we questioned whether neutrophils depleted of arachidonate as a result of essential fatty acid deficiency might be functionally impaired. We examined this possibility by producing essential fatty acid deficiency in monkeys with lipid-free total parenteral nutrition (TPN). Rhesus and African green monkeys were given calorically equal TPN for up to 23 days with and without a vegetable fat emulsion rich in linoleic acid. Fatty acids were analyzed in total lipid extracts of serum and isolated blood neutrophils by gas-liquid chromatography. Although fatty acids in the serum and neutrophils of monkeys given TPN with lipid did not change, linoleic acid levels decreased by at least 60% in serum and 50% in neutrophils from animals given TPN with no lipid. Moreover, arachidonate levels in neutrophil lipids decreased by at least 50% within 12 days of lipid-free TPN, and the abnormal fatty acid 20:3 omega 9 (characteristic of essential fatty acid deficiency) appeared and steadily increased with time. These biochemical signs of omega 6 fatty acid deficiency were associated with impaired neutrophil function in vitro. Both migration responses and superoxide generation stimulated by N-formyl-methionyl-leucyl-phenylalanine were significantly decreased by 12 days of lipid-free TPN, as was the capacity of activated cells to synthesize leukotriene B4. In contrast, functional responses of fatty acid-deficient neutrophils to leukotriene B4 and phorbol myristate acetate, which have little or no effect on arachidonate release or metabolism, were not significantly altered. These findings indicate that endogenous supplies of arachidonic acid and other essential omega 6 fatty acids influence the functional responsiveness of neutrophils. These studies also indicate that altered neutrophil function is a feature of essential fatty acid deficiency and that it may contribute to the increased risk of infection and decreased inflammatory responses observed in this condition.     

Parenteral N-3 fatty acids modulate inflammatory and immune response in rats undergoing total gastrectomy

This study investigated the effect of n-3 fatty acid (FA)-containing parenteral nutrition on the circulatory lymphocyte subpopulation, intracellular cytokine and leukocyte adhesion molecule expression, and phagocytic activity in rats undergoing total gastrectomy. Normal rats with internal jugular catheters were assigned to normal control (NC) and two experimental groups and received total parenteral nutrition (TPN). At the same time, a total gastrectomy was performed in the experimental groups, whereas the NC group underwent a sham operation. The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in fat emulsion contents. The NC and one of the experimental groups received a soybean oil emulsion (SO), and the other experimental group received 50% soybean oil and 50% fish oil emulsion (FO). Half of the rats in each respective group were sacrificed 1 or 3 days after surgery or the sham operation to examine their immune response. The results showed that the FO group had a higher CD4 proportion and CD4/CD8 ratio than those of the SO and NC groups postoperatively. The phagocytic activity of peritoneal macrophages was higher in the FO group than in the NC group, but no difference was found between the SO and NC groups 3 days after surgery. The intracellular interferon (IFN)-gamma distribution in the FO group was higher than that of the SO group on postoperative days. Leukocyte adhesion molecule expressions and peritoneal monocyte chemotactic protein-1 levels were lower in the FO group than in the SO group on postoperative day 3. These results suggest that parenterally infused FO did not result in immunosuppression. In addition, FO administration promotes lymphocyte Th1 cytokine production, enhances peritoneal macrophage phagocytic activity, and reduces leukocyte adhesion molecule expression in rats with total gastrectomy.     

同、反相位MRI诊断大鼠非酒精性脂肪肝

目的 探讨应用同、反相位MRI诊断大鼠非酒精性脂肪肝及评价脂肪肝病变程度的价值。方法 选取雄性Wistar大鼠40只,实验组30只,对照组10只,实验组采用高脂、高胆固醇喂养,对照组采用普通饮食,12周后行MRI、血脂生化及病理学检查,将两组的血脂生化指标及同、反相位MRI测得的肝脏脂肪分数(HFF)与病理结果进行比较及相关性分析。结果 实验组30只大鼠中脂肪肝1级5只,2级12只,3级13只,对照组10只均为0级;同、反相位MRI诊断脂肪肝的敏感度为100%(30/30),特异度为80.00%(8/10),准确率为95.00%(38/40)。实验组与对照组的血脂生化指标差异有统计学意义(P均<0.05),但在实验组不同分级脂肪肝间的差异均无统计学意义(P均>0.05)。同、反相位肝脏HFF与组织病理学测得的脂肪变肝细胞比例呈正相关(r=0.963)。结论 同、反相位MRI对诊断大鼠脂肪肝及判定脂肪肝病变程度具有较高价值。     

Experiences with MCT containing fat emulsions in premature and newborn infants

Total parenteral nutrition (TPN) was given for 8-9 days to 15 prematures and full term neonates (gestational age 26-40 weeks) with respiratory problems or respiratory distress syndrome (RDS). The solutions were administered via peripheral veins during 24 h. Serum electrolytes, calcium, triglycerides and amino acids were measured before and on the 2nd, 4th and 7th day of TPN acid-base balance, blood glucose and serum bilirubin were measured daily and serum transaminases and total protein on the final day of TPN. The total amount of findings administered was 126 ml/kg BW/day and consisted of 10.4 g glucose, 1.9 g fat and 1.95 g amino acids with the total amount of calories reaching an average of 68.7 kcal/kg BW/day (61% glucose, 27.6% fat and 11.4% protein). Three children (2 very small prematures, 1 with severe perinatal asphyxia) died of causes unrelated to TPN. Serum electrolytes, calcium and blood glucose levels were in the normal range in all cases, acid-base balance was affected minimally and moderate hyperbilirubinemia was observed in all neonates. Serum transaminase values were in the normal range as was total protein. Hypertriglyceridemia with values over 3 mmol/l was observed in the very premature neonates and in one neonate with septicemia. Our findings are in favor of administration of MCT fat emulsion to prematures and full term neonates.