乌司他丁辅助治疗对重症监护室脓毒症患者炎症反应及器官功能的影响

目的:探究分析乌司他丁辅助治疗对重症监护室脓毒症患者炎症反应及器官功能的影响。方法:选定入住某院重症监护室的脓毒症患者86例,研究时段自2014年1月～2018年11月,分组参考治疗方式差异性原则,分为对照组(常规治疗)和试验组(乌司他丁辅助治疗)各43例,对全部患者资料进行回顾性分析,比较炎症反应情况和器官功能变化情况。结果:试验组治疗前1周白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、血尿素氮(BUN)、谷丙转氨酶(ALT)、肌酸激酶(CK)含量与对照组相比存在差异但不显著(P0.05);治疗2周后评估两组上述指标均降低,且试验组低于对照组(P0.05)。结论:在重症监护室脓毒症患者治疗中,乌司他丁辅助治疗可改善患者炎症反应情况,提高心、肝、肾脏功能,利于患者机体整体状态改善,值得借鉴。     

前列腺素类、巯基和一氧化氮对黄芪皂苷Ⅳ胃保护作用的影响

前期研究发现,富含n-3多不饱和脂肪酸(n-3PUFA)的饮食能缓解由脂多糖(LPS)诱导的系统性炎症小鼠食欲及探究行为的减退,但含n-3PUFA的饮食对不同炎症条件下行为的作用鲜有报道。为此作者进行了以下实验。实验选用雄性ddY小鼠,实验饲料中有富含n-3PUFA的紫苏子油(质量分数10%,n-3     

强化ω-3多不饱和脂肪酸的肠内营养支持对高脂血症性急性胰腺炎患者免疫功能的影响

目的探讨强化ω-3多不饱和脂肪酸的肠内营养支持对高脂血症性急性胰腺炎患者免疫功能的影响。方法将80例高脂血症性急性胰腺炎患者按随机数字表法分为治疗组40例和对照组40例。2组患者均给予急性胰腺炎规范治疗,对照组给予肠外营养支持,治疗组经空肠营养管给予强化ω-3多不饱和脂肪酸的肠内营养支持。治疗后比较2组患者营养指标、体液免疫指标和细胞免疫指标、炎症反应指标的变化情况。结果2组患者给予不同营养方式治疗后,治疗第7天、14天时血清白细胞(ALB)和血清前白蛋白(PAB)水平以治疗组提高更为显著(均P<0.05)。治疗第14天时IgA,IgG,IgM,淋巴细胞总数(TLC),CD3,CD4以治疗组上升更显著(均P<0.05);同时2组患者治疗后的CRP,TNF-α,IL-6水平呈现下降趋势,治疗组下降更显著(均P<0.05)。结论强化ω-3多不饱和脂肪酸的肠内营养支持治疗高脂血症性急性胰腺炎患者能更加有效地改善患者营养状况及免疫功能,降低患者急性反应期炎症反应,从而改善预后、提高临床疗效。     

添加n-3脂肪酸的全肠外营养对外科全身炎症反应综合征患者的影响

目的:探讨添加n-3脂肪酸的全肠外营养(TPN)对外科全身炎症反应综合征(SIRS)患者的影响。方法:将48例诊断SIRS的外科危重症患者随机分为实验组(含n-3脂肪酸)和对照组(不含n-3脂肪酸),均给予常规外科治疗及连续TPN 5 d,分别于TPN前1天和后第5天抽取外周静脉血,测量炎症反应指标:C反应蛋白(CRP)、TNF-α、IL-1、IL-6、IL-8;肝脏和胰腺功能:血清天冬氨酸氨基转移酶(ASAT)、丙氨酸氨基转移酶(ALAT)、胆红素(TBIL)、脂肪酶(LPS);并分别进行APACHE评分。结果:所有患者均无不良反应发生,两组CRP、TNF-α、IL-1、IL-6、IL-8、ASAT、ALAT、TBIL、LPS、APACHE评分研究结束时均有改善(P<0.05),但实验组改善优于对照组,差异有显著性(P<0.05)。结论:添加n-3脂肪酸的TPN对SIRS患者在阻断过度炎症反应、保护重要器官功能方面发挥了重要的作用,有利于细胞及器官功能的恢复。     

乌司他丁在婴幼儿重症感染治疗中的作用

目的观察乌司他汀在婴幼儿重症感染治疗中的作用。方法将60例重症感染患儿随机分为试验组和对照组各30例。入院后,2组均给予抗感染、营养支持、维持水电解质酸碱平衡、对症支持治疗及原发症治疗。试验组在此基础上给予乌司他汀治疗。观察2组体温(T)、呼吸频率(RR)、心率(HR)、白细胞(WBC)及C-反应蛋白(CRP)等炎性反应相关指标的变化情况。结果治疗后2组T、RR、HR均较治疗前明显下降,差异均有统计学意义(P<0.05或P<0.01)。试验组治疗后WBC较治疗前明显下降,差异有统计学意义(P<0.01);且试验组治疗后RR水平低于对照组,差异有统计学意义(P<0.05)。治疗3d后2组血清CRP水平均较治疗前明显下降,且试验组较对照组下降更为明显,差异有统计学意义(P<0.05或P<0.01)。结论乌司他汀用于婴幼儿感染治疗,可有效调控炎性反应,在感染控制中发挥重要作用。     

n-3多不饱和脂肪酸在不同疾病中的研究进展

<正>n-3多不饱和脂肪酸(n-3PUFAs)指多不饱和脂肪酸中第1个不饱和键出现在碳链甲基端的第3位,对人体健康状况起着重要的作用,n-3PUFAs主要包括α-亚麻酸(α-linolenic aicd,ALA,18:3n-3),二十碳五烯酸(eicosapentaenoic acid,EPA,20:5n-3),二十二碳六烯酸(docosahexaenoic acid,DHA,22:6n-3)等,其中含丰富的α-亚麻酸是人体     

连续性肾替代疗法在重症多发性创伤治疗中的应用价值

目的探讨连续性静脉-静脉血液滤过(CVVH)在阻断重症多发性创伤(SMI)所致的全身炎症反应综合征(SIRS)向多器官功能障碍综合征(MODS)发展中的作用及机制。方法58例重症多发性创伤伤员随机分为试验组(n=31)和对照组(n= 27),并选20名健康体检者为健康组。对照组予常规综合治疗,试验组在常规综合治疗的同时加CVVH治疗。两组同时检测血清白介素-6(IL-6)、白介素-Iβ(IL-Iβ)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平,并观察SIRS临床指标的变化;健康组血检结果作为健康对照。结果试验组T、RR、HR及WBC改善情况均明显优于对照组(P<0.05或P<0.01);血清CRP、IL-Iβ、IL-6和TNF-α水平均较对照组下降更为明显(P<0.01);转为MODS明显减少(P<0.05),死亡率明显降低(P<0.05)。结论CVVH可通过下调炎症介质,调控机体炎症反应,阻断重症多发性创伤所致的SIRS向MODS发展。     

连续性血液净化在重症脓毒血症患者中的应用效果及对血小板的影响

目的探究临床上重症脓毒血症的治疗中,采用连续性血液净化的效果和价值。方法选取2018年6月至2021年6月南宁市第一人民医院收治的100例重症脓毒血症患者作为研究对象,采用随机数字表法分为对照组（50例）和试验组（50例）,对照组采用常规治疗方法,试验组采用连续性血液净化治疗方法。比较两组患者的不良反应总发生率、临床疗效、血小板含量、肾功能指标以及炎症因子水平。结果 试验组的不良反应总发生率低于对照组,且临床疗效高于对照组,血小板含量低于对照组,差异有统计学意义（P<0.05）;治疗前两组的肌酐、尿素氮、C反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义（P>0.05）,治疗后,试验组的肌酐、尿素氮、CRP、PCT、TNF-α低于对照组,差异有统计学意义（P<0.05）。结论 对重症脓毒血症患者进行连续性血液净化治疗的效果显著,能够改善患者的肾功能指标以及炎症因子水平。     

乌斯他丁在急性重症胰腺炎围手术期应用研究(附30例报告)

目的探讨乌斯他丁对急性重症胰腺炎患者围手术期肝肾功能保护及抑制炎症反应作用。方法以需手术治疗的急性重症胰腺炎患者57例为研究对象,随机分配为观察组30例,对照组27例。观察组在常规治疗的基础上,连续5天给予20万u乌斯他丁静脉滴入,对照组仅予以常规治疗,同时术前、术后1、3、6天检测血白细胞介素-10(IL-10)、肝功能及肾功能指标。结果术后第3天观察组AST平均值低于对照组(P<0.05),术后第3天观察组IL-10水平低于对照组,差别有统计学意义(P<0.05);两组术后的血肌酐有明显差异(P<0.01)。结论乌斯他丁对急性重症胰腺炎患者围手术期的肝肾功能有保护及抑制炎症反应作用。     

肺部感染评分及全身炎症反应综合征修正评分对重型颅脑损伤继发感染临床诊疗价值分析

目的探讨肺部感染评分及全身炎症反应综合征修正评分对重型颅脑损伤继发感染临床诊疗价值,为临床治疗提供依据。方法收集2013年7月至2015年5月在我院就诊的152例符合标准的重型颅脑损伤患者的发生感染时间、主要感染类型、发生感染概率及主要死因等资料,采用全身炎症反应综合征修正评分与肺部感染评分,评价指标有患者住重症监护病房(ICU)时间、感染控制时间、住院内的存活情况和住院时间,其中住院内的存活情况作为最重要评价指标,进行统计学分析。结果肺部感染评分存活组评分低于死亡组,差异有统计学意义(P<0.05);全身炎症反应综合征修正评分存活组评分低于死亡组,差异有统计学意义(P<0.05);其中全身炎症反应综合征修正评分与在ICU所住时间、感染控制时间、住院时间呈正相关关系。结论肺部感染评分及全身炎症反应综合征修正评分对重型颅脑损伤继发感染均具有一定的评估意义。     

Fish oil and mental health: the role of n-3 long-chain polyunsaturated fatty acids in cognitive development and neurological disorders

Epidemiological and experimental studies have indicated that consumption of more n-3 long-chain polyunsaturated fatty acids may reduce the risk for a variety of diseases, including cardiovascular, neurological and immunological disorders, diabetes and cancer. This article focuses on the role of marine n-3 long-chain polyunsaturated fatty acids in brain functions, including the development of the central nervous system and neurological disorders. An overview of the major animal studies and clinical trials is provided here, focusing on fatty acid supplementation during pregnancy and infancy, and prevention and management of Alzheimer's disease, schizophrenia, depression and attention deficit hyperactive disorder. Although an optimal balance in n-3/n-6 long-chain polyunsaturated fatty acid ratio is important for proper neurodevelopment and cognitive functions, results from randomized controlled trials are controversial and do not confirm any useful effect of supplementation on development of preterm and term infants. The relationship between fatty acid status and mental disorders is confirmed by reduced levels of n-3 long-chain polyunsaturated fatty acids in erythrocyte membranes of patients with central nervous system disorders. Nevertheless, there are very little data supporting the use of fish oil in those patients. The only way to verify whether n-3 long-chain polyunsaturated fatty acids are a potential therapeutic option in the management and prevention of mental disorders is to conduct a large definitive randomized controlled trials similar to those required for the licensing of any new pharmacological treatment.     

Unsaturated fatty acids and pain

Fatty acids, which are the essential nutrients for humans, are an important source of energy and an essential component of cell membranes. They also function as signal transduction molecules in a range of biological phenomena. Recently, an increasing number of physiologic and pharmacologic reports on fatty acids have improved our understanding of the association of fatty acids with certain diseases. It has also become apparent that functional properties of fatty acids are modulated by factors such as the amount of individual fatty acid intake and their distribution among organs. Recently, the functional relationship between polyunsaturated fatty acids and pain has been the focus of many studies. Both basic and clinical studies have shown that a dietary intake of n-3 series polyunsaturated fatty acids results in a reduction in the pain associated with rheumatoid arthritis, dysmenorrhea, inflammatory bowl disease, and neuropathy. In addition, levels of n-6 series polyunsaturated fatty acids are high in patients with chronic pain. These results indicate that polyunsaturated fatty acids play a vital role in pain regulation. In this review, we summarize a number of basic and clinical studies on polyunsaturated fatty acids and their association with pain.     

Polyunsaturated fatty acids (n-3 PUFAs) and inflammatory bowel disease (IBD): pathogenesis and treatment

There is considerable evidence to suggest that polyunsaturated fatty acids (PUFAs) alleviate a number of inflammatory diseases, mainly the fish derivatives, n-3 PUFAs. My aim is to briefly review the literature involving clinical interventions with these lipid compounds in the treatment of Ulcerative Colitis (UC) and Crohn's Disease (CD), Inflammatory Bowel Disease (IBD). Data available are conflicting and the reason for the discrepancies in the findings could reside in the different study designs. Often studies are limited by the choice of placebo and insufficient washout period and direct comparison of trials is hampered by the use of various formulations and dosages of n-3 PUFAs. The importance of the n-3 PUFAs formulation in lowering the incidence of side effects along with careful selection of patients and experimental design seems to be associated with benefits. It is possible these fatty acids act by reducing low-grade active inflammation rather than by preventing reinitiation of the inflammatory process from a truly quiescent state. Whether this treatment is applicable to all patients with IBD has not been fully elucidated. Nevertheless, taken together, all these studies suggest the effectiveness of these new therapeutic approaches, not only when the conventional treatment fails or it is not possible to treat chronically, but also, in some instances as first choice.     

n-3多不饱和脂肪酸类药物在心血管疾病中的临床应用进展

许多临床试验表明n-3多不饱和脂肪酸(n-3 PUFAs)对于冠心病、血脂异常和心力衰竭等人群均具有保护作用,而且已有建议推荐心肌梗死后患者和高甘油三酯血症人群口服此类提纯药物。但在应用过程中,仍有一些值得临床关注的问题,如药物安全性、药物成分和用量等。笔者认为,随着对n-3 PUFAs药物的深入研究,其将有更广阔的应用前景。     

Fish oils and vascular disease prevention: an update

Considerable epidemiological data confirmed the existence of favorable associations between fish consumption and mortality from cardiovascular disease. Accumulating evidence suggests that n-3 polyunsaturated fatty acids supplementation is an effective additive treatment for the primary and secondary prevention of cardiovascular disease. Another indication for the use of n-3 PUFA is the treatment of hypertriglyceridemia as monotherapy or in combination with other lipid lowering agents (e.g. statins or fibrates). However, high doses of n-3 PUFA are required for this effect (e.g. 3-4 g/day). Fish oils may be acting via several mechanisms that include antiarrhythmic, antithrombotic and anti-inflammatory effects as well as plaque stabilization. Despite the current evidence supporting a beneficial effect of fish oils on vascular disease, more definitive studies than the ones already performed are required. Some ongoing trials may provide further insight into the indications for fish oil supplementation. This review considers the mechanisms accounting for the cardioprotective properties of n-3 polyunsaturated fatty acids. We also discuss the epidemiological and interventional studies evaluating the relationship between n-3 polyunsaturated fatty acids consumption and cardiovascular disease.     

N-3 polyunsaturated fatty acid effect in periodontal disease: state of art and possible mechanisms involved

Anti-inflammatory properties have been widely reported for n-3 polyunsaturated fatty acids (PUFAs) and some studies have been focalized on their possible role in the modulation of gingivitis and alveolar bone resorption in periodontal disease (PD). Increased formation of arachidonic acid-derived inflammatory eicosanoids and augmented oxidative stress are two molecular mechanisms pathogenetically involved in the progression of PD and known to be inhibited by n-3 PUFAs in PD setting. The present review will focus also on other molecular pathways and factors known to be altered in the development of PD and known to be subject to n-3 PUFA modulation in other pathological settings different from PD. Overall, the available findings strongly encourage further experimental studies on animals subject to experimental PD and treated with n-3 PUFAs, long term n-3 PUFA intervention studies on PD patients and molecular studies to identify additional potential molecular routes of n-3 PUFA action in PD.     

Prolonged n-3 polyunsaturated fatty acid supplementation ameliorates hepatic steatosis in patients with non-alcoholic fatty liver disease: a pilot study

BACKGROUND: Recent studies suggest a role of n-3 long-chain polyunsaturated fatty acids (n-3 PUFA) as peroxisome proliferator-activated receptor-alpha ligands in improving non-alcoholic fatty liver disease (NAFLD) in rodents. However, data in humans are still lacking. AIM: To evaluate the efficacy of prolonged PUFA supplementation in patients with NAFLD. METHODS: Fifty-six patients with NAFLD were enrolled. Among the overall eligible patients, 42 assumed n-3 PUFA 1-g capsule daily for 12 months, whereas 14 refused the treatment and were analysed as controls. All patients underwent haematochemical and ultrasound follow-up. RESULTS: Polyunsaturated fatty acid supplementation significantly decreased serum aspartate transaminase (P = 0.003), alanine transaminase (P = 0.002), gamma-glutamyl transpeptidase (P = 0.03), triglycerides (P = 0.02) and fasting glucose (P = 0.02) in comparison with controls. Circulating arachidonate and n-6/n-3 fatty acid ratio was reduced (P = 0.0002, and P = 0.0001 respectively) in treated patients. Moreover, ultrasonography demonstrated improvement of liver echotexture after PUFA (P = 0.0001), and increase of Doppler perfusion index (P = 0.001), whereas no significant changes occurred in controls. CONCLUSIONS: Supplementation with n-3 PUFA improves biochemical, ultrasonographic and haemodynamic features of liver steatosis. Our study supports the efficacy of n-3 PUFA as a new therapeutic approach in the treatment of NAFLD.     

The role of n-3 polyunsaturated fatty acids in the prevention and treatment of cardiovascular disease

Growing evidence has suggested an important role of n-3 polyunsaturated fatty acids in reducing risk of cardiovascular disease in the general population and patients with preexisting heart disease. In particular, several long-term epidemiologic studies have found an inverse association between fish consumption and risk of coronary heart disease or stroke. Two secondary prevention trials have found that increasing fish consumption or fish oil supplementation significantly reduced coronary death among patients with existing myocardial infarction. In addition, epidemiologic and clinical studies have suggested that alpha-linolenic acid (ALA), a short-chain n3-3 fatty acid from plant sources, may have similar cardiac benefits as long-chain n-3 fatty acids from fish. Potential mechanisms through which n-3 polyunsaturated fatty acids protect against CVD include their antiarrhythmic and antithrombotic effects, and improving insulin sensitivity and endothelial function. (c) 2001 Prous Science. All rights reserved.     

Long-chain n-3 polyunsaturated fatty acids: new insights into mechanisms relating to inflammation and coronary heart disease

Evidence from observational studies, prospective cohort studies and randomized clinical intervention studies indicate that moderate doses of long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) significantly decrease risk of fatal coronary heart disease (CHD). Higher doses and longer duration of intervention may also protect from non-fatal CHD events. The exact mechanisms through which LC n-3 PUFA has an effect on CHD are not well established but may include a decrease in fasting and postprandial triacylglycerol levels, a decrease in arrhythmias, modulation of platelet aggregation and decreased synthesis of pro-inflammatory agents. The mechanistic relation between LC n-3 PUFA and inflammation has attracted great interest, and in vitro studies have revealed that these fatty acids decrease endothelial activation, affect eicosanoid metabolism (including epoxygenation pathways) and induce inflammatory resolution. However, the effects of LC n-3 PUFA on established biomarkers of inflammation and endothelial activation in vivo are not strong. Consequently we need new and more sensitive and systemic biomarkers to reveal the effects of LC n-3 PUFA on localized inflammatory processes.