肝外梗阻性黄疸病人的血清脂类代谢变化研究

对12例梗阻性黄疸和15例无脂肪代谢紊乱的非梗阻性黄疸病人血清中各种脂类进行检测，发现梗黄病人血清中4种饱和脂肪酸（C12：0、C14：0、C16：0、C18：0）和油酸（C18：1）含量升高，而C18：2和C18：3两种必需脂肪酸（EFA）降低，6／3脂肪酸比值降低。甘油三酯（TG）和胆固醇（Tch）升高，高密度脂蛋白（HDL）降低，低密度（LDL）、极低密度脂蛋白（VLDL）升高。结果表明，梗黄病人存在严重的脂类代谢紊乱，即在脂肪动员同时，存在EFA缺乏，以6脂肪酸缺乏更明显，并且机体输送外源性脂肪能力下降。     

急性心肌梗死早期的血脂分析

目的探讨急性心肌梗死早期血脂变化特点。方法267例疑诊或确诊为冠心病的患者，均行冠状动脉造影（CAG）。根据病史、实验室检查及CAG分三组：冠脉正常组、急性心肌梗死组、非急性心肌梗死组。所有患者均于入院次日化验血脂。结果急性心肌梗死组早期（发病24-36h内）血脂水平已出现明显变化：总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白-胆固醇（HDL—C）、低密度脂蛋白-胆固醇（LDL—C）、载脂蛋白（Apo）A均下降。与冠脉正常组相比。TC、TG、LDL—C差异无统计学意义；与非急性心肌梗死组相比，TC、LDL—C、ApoA差异有统计学意义（P〈0．05）。结论急性心肌梗死早期血脂TC、HDL—C、LDL—C、ApoA降低，不应以此时的水平作依据，而应早期积极干预治疗。     

创伤后血脂变化及20%脂肪乳剂对血脂的影响

本文以１４例胆囊切除术病人为创伤模型，观察了创伤及给予２０％脂肪乳剂后血的变化。术后甘油三酯下降主要是创伤应激、内源性甘油三酯合成减少、机体对脂肪利用增加的结果。总胆固醇的下降则是应激状态下来源于糖代谢的合成底物减少及禁食有关酶类受抑制的结果。创伤后机体对外源性脂肪乳剂廓清能力增强，给予２０％脂肪乳剂后，能够提高血脂水平。改善脂代谢。对于创伤后的病人，作为能量的贮存或供给都具有重要意义。     

广州市18岁以下人群血脂水平的统计分析

目的：了解广州市18岁以下人群血脂水平的现状，为以后该人群的血脂水平跟踪提供数据。方法：采用多阶段随机抽样，抽取广州市1390例（男／女=701／689）18岁以下人群，采集空腹静脉血测定总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、甘油三酯（TG），对结果进行分析。结果：本次研究中，总胆固醇（TC）异常率为7．1％（98／1390），甘油三酯（TG）升高率为6．3％（88／1390）；高密度脂蛋白胆固醇（HDL—C）降低率为8．8％（122／1390）；低密度脂蛋白胆固醇（LDL—C）升高率为7．1％（99／1390）；TC、HDL—C、LDL—C与年龄存在正相关，TG与年龄存在负相关；TC、HDL—C、LDL—C、TG、年龄这5项之间呈显著性相关，性别与这些指标则无显著相关性。结论：本调查结果示广州市18岁以下人群中，绝大部分血脂水平处于正常状态，但也有一定比例的青少年存在血脂异常状况，该调查数据对日后的该人群血脂水平跟踪调查有很重要意义。     

辛伐他汀对急性心肌梗死患者血脂水平和C反应蛋白的影响

目的：研究辛伐他汀对急性心肌梗死（AMI）患者早期血脂水平和血浆C反应蛋白（CRP）的影响。方法：40例AMI患者随机分为2组，常规用药组20例，常规用药加用辛伐他汀（即联用组）组20例，并附正常人组20例。并测定治疗前后的血脂（TC，TG，LDL—C，HDL—C）水平和C反应蛋白（CRP）的水平。结果：AMI患者早期血浆患者CRP水平较健康组明显升高（P〈0．05）；治疗4周后两组CRP水平均较本组治疗前明显下降（P〈0．05），但治疗组下降更显著，治疗组与常规组治疗后比较，有显著性差异（P〈0．05）。联用组治疗后与治疗前比较TC，TG，LDL—C明显降低，HDL—C明显升高。结论：常规用药加用辛伐他汀能显著降低AMI患者的血脂水平，改善AMI患者早期血浆中CRP水平。     

高血压病人血脂和脂蛋白水平变化与肾损害的关系

目的探讨高血压病人血脂、脂蛋白水平变化与肾损害的关系。方法将106例高血压患者分为高血压未发生肾损害组（n=44）、高血压早期肾损害组（n=40）、高血压肾损害组（n=22），以104例血压正常者作为对照组，检测血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1及B（apoA1、apoB）、脂蛋白（a）[LP（a）]，进行比较分析。结果高血压病人血清TC、TG、HDL—C、LDL-C、apoB、LP（a）水平明显高于正常对照组，差异有显著性意义（P均〈O．01），HDL-C水平明显高于正常对照组p〈0．05）。TC、LDL—C、apoB水平随高血压早期肾损害的加重呈现升高的趋势，高血压肾损害组病人血清LP（a）水平及异常率明显高于高血压早期肾损害组和未发生肾损害组，差异有显著性意义（p〈0．05，p〈0．01），其余各指标异常率均无显著性意义。结论高血压病人存在着明显的脂质异常，高血压肾损害与脂质代谢紊乱相关联，肾损害加重脂质代谢紊乱。     

北京市不同营养状况中学生血脂状况调查

目的 了解不同营养状况青少年血脂水平及其异常情况，为早期预防心脑血管疾病提供理论依据。方法 对北京市966名初中三年级学生进行体检和血脂检测，分体重正常组、超重组和肥胖组进行血清学各指标比较。结果 随体质指数（BMI）增高，血清总胆固醇（TC）、甘油三脂（TG）和低密度脂蛋白胆固醇（LDL—C）水平及其异常检出率呈增高趋势，不同组间差异有统计学意义（P〈0．05）；HDL—C在超重组和肥胖组差异无统计学意义（P〉0．05），其余2组比较差异有统计学意义（P〈0．05）。结论 肥胖青少年血脂水平及其血脂异常率较高，应积极预防和治疗青少年高脂血症。     

老年2型糖尿病患者血脂代谢分析

目的：探讨老年2型糖尿病患者的血脂水平情况。方法：利用生化方法检测38例老年2型糖尿病患者及34例正常血糖老年患者的甘油三酯（TG）、总胆固醇（TC）及低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL-C）等水平进行比较分析。结果：老年2型糖尿病组的甘油三酯、总胆固醇及低密度脂蛋白胆固醇（LDL—C）、ApoB水平明显高于对照组,高密度脂蛋白胆固醇（HDL—C）、ApoA低于对照组,比较差异有统计学意义（P〈0．05）。结论：老年2型糖尿病患者存在血脂代谢异常,积极控制血糖及血脂可以延缓心脑血管并发症发生。     

老年冠心病血清胆红素浓度变化及其与血脂的关系

目的：探讨老年冠心病患血清胆红素浓度的变化及其与血脂的关系，方法：分别检测75例老年冠心病患与45例对照的血清总胆红素（TBIL），直接胆红素（DBIL），间接胆红素（IBIL） 度以及血清总胆固醇（TC），甘油三脂（TG），极低密度脂蛋白胆固醇（VLDL－C）水平，结果：冠心病组TBIL，IBIL浓度均低于对照组，差异有非常显意义（P＜0．01），DBIL浓度也显低于对照组（P＜0．05），TBIL，DBIL，分别与TG，VLDL－C呈显负相关（P＜0．05），结论：老年人血清胆红素浓度的降低可能参与了冠心病的发病机制，血清胆红素与血脂负相关。     

脂肪乳剂对围手术期胃肠道肿瘤病人细胞免疫功能的影响

为了观察脂肪乳剂对肿瘤病人围手术期细胞免疫功能的影响，将14名病理证实的进展期胃肠道癌症病人分为二组，TPN-力能组，力能提供30％非蛋白热卡，TPN-葡萄糖组，葡萄糖提供100％非蛋白热卡。能量给予105kj·kg-1·d-1，N0．12g·kg-1·d-1，营养液以“全合一”液匀速输入，分别于术前、营养前、营养后4天抽取外周血测定T细胞亚群、NK细胞及IL-2细胞。结果表明，T亚群中CD3，CD4，CD8，NK细胞及IL－2分泌细胞在手术后明显下降，经TPN营养支持4天后回升。研究结论：（1）手术创伤降低机体细胞免疫功能。（2）20％力能提供30％非蛋白热卡可使手术创伤应激期机体免疫功能恢复。使创伤后免疫障碍病人，在TPN后细胞免疫恢复至术前水平，可以说明在创伤应激期脂肪乳剂的适量应用是有益的，并不产生细胞免疫抑制。     

Influences of soybean oil emulsion on stress response and cell-mediated immune function in moderately or severely stressed patients

OBJECTIVES: We previously reported that omega-6 fat emulsion increases cytokine production in burned rats. Effects of soybean oil emulsion on surgical stress responses and lymphocyte function according to the surgical severity have not been studied in detail. We investigated the effects of soybean oil emulsion, which contains 50% omega-6 fatty acid, on postoperative stress responses and cell-mediated immune function according to the severity of surgical stress. METHODS: Eight patients who underwent gastric or colorectal surgery and nine who underwent esophagectomy were fed fat-free total parenteral nutrition. Ten patients who underwent gastric or colorectal surgery and seven who underwent esophagectomy were fed total parenteral nutrition with soybean oil emulsion. Total parenteral nutrition provided 1.5 g of protein and 40 kcal per kilogram every day from 7 d before surgery to postoperative day 14. Soybean oil emulsion (Intralipid) accounted for 20% of the total calories. Serum interleukin-6, C-reactive protein, glucagon, and concanavalin A- or phytohemagglutinin-stimulated lymphocyte proliferation were determined. RESULTS: In the group of moderately stressed patients, soybean oil emulsion did not amplify the measured levels. In the group of severely stressed patients, soybean oil emulsion amplified the level of serum interleukin-6 and decreased concanavalin A- or phytohemagglutinin-stimulated lymphocyte proliferation. CONCLUSIONS: Soybean oil emulsion amplifies the stress responses and possibly suppresses cell-mediated immune function induced by surgical stress in severely stressed patients, but not in moderately stressed patients.     

Effect of severity of stress on whole-body protein kinetics in surgical patients receiving parenteral nutrition

A study was conducted to clarify the quantitative relationship between the alteration of protein metabolism and the severity of surgical stress to further understand the mechanisms of body nitrogen losses in surgical trauma. Twenty-one patients undergoing esophagectomy for esophageal cancer (group E), and 22 undergoing gastrectomy or colorectal operations for gastric or colorectal cancer (Group GC) were studied. All patients were fed exclusively by parenteral nutrition (PN) providing 1.5 g protein · kg⁻¹ · d⁻¹ and 35 kcal · kg⁻¹ before and after the operation. The measurements of whole-body protein turnover, synthesis, and breakdown were performed preoperatively and on postoperative days (PODs) 3 and 10. Urinary excretion of total nitrogen and total catecholamines was also measured. Urinary excretion of the total catecholamines of group E was twice as high as that of group GC on the POD 3 and well reflected the severity of surgical stress. Negative correlation of nitrogen retention to urinary excretion of the total catecholamines was also observed (r = 0.64; P < 0.01). The correlations between the urinary excretion of the total catecholamines and the whole-body protein flux, synthesis, and breakdown were statistically significant (r = 0.57, 0.27, and 0.57, respectively; P < 0.01 in all). Rate of elevation in breakdown according to the stress level was greater than that of synthesis. Consequently the progressive aggravation of nitrogen balance according to the severity of surgical stress was observed.     

Resting energy expenditure in cancer patients before and after gastrointestinal surgery.

The aim of this study was to assess the impact of surgical trauma on energy metabolism in cancer patients. Therefore, resting energy expenditure (REE) was determined before and after surgery in patients with newly detection gastric and colorectal cancer. Preoperative REE was measured in 104 patients. In 65 of these 104 patients REE was also measured on the seventh or eighth postoperative day. Postoperative REE was significantly higher than preoperative REE (mean +/- SD: 1471 +/- 238 vs 1376 +/- 231 kcal; p less than 0.001). After surgery 22 patients were hypermetabolic (REE greater than or equal to 115% predicted energy expenditure) compared with seven hypermetabolic patients before surgery. This hypermetabolism in the postoperative state can be explained by the administration of total parenteral nutrition (TPN), by an increased body temperature mainly as a consequence of postoperative complications and by the surgical trauma itself. Patients who received preoperative TPN (n = 12) showed a 10% increase in REE. Thirteen patients suffered from minor and major postoperative complications; postoperative REE in this group was increased by 10%. Forty patients who had undergone uncomplicated surgery showed a slight but significant increase of 3% in REE after operation. We conclude from this study that the increase in REE resulting from surgical trauma itself is modest at the seventh to eighth postoperative day. Therefore, energy requirements for patients undergoing major elective surgical stress are lower than generally presumed.     

The effects of major abdominal surgery, enteral and parenteral nutrition on pancreatic function and morphology

The effects of major abdominal surgery and nutritional support upon pancreatic function and morphology were studied in similar groups of patients who underwent major abdominal surgery (n = 18), received parenteral nutritional support (n = 18) or received enteral nutritional support (n = 16). The exocrine function of the pancreas was measured by means of an oral pancreatic function test (using 1 g of N-benzoyl-L-tyrosyl para-aminobenzoic acid) with measurement of serum para-aminobenzoic acid at 3 h and the Pancreatic Excretion Index. Pancreatic morphology was assessed by real time ultrasound and a pancreatic size index was calculated (maximum diameter of head x body). Serial measurements of function and morphology were carried out in each patient at entry into the study and at 7 and 14 days after operation or start of nutritional support. Serum PABA levels were similar in the 3 groups at the start of the study. Although the levels remained unchanged in the enteral and parenteral groups, a significant and progressive decrease was observed in the surgical group (serum PABA = 27.5 nmol/l (24.0-30.6) before operation, 10.5 nmol/l (5.5-13.4) 14 days after operation, P < 0.01). No significant changes in pancreatic size were seen. Parenteral and enteral nutrition preserves pancreatic exocrine function. A dramatic reduction in pancreatic exocrine function is seen after major abdominal surgery.     

胃癌全胃切除术后肠内营养对血浆游离脂肪酸的影响

目的探讨胃癌全胃切除术后肠内营养对血浆游离脂肪酸的影响。方法将30例胃癌行全胃切除术后的患者,随机分为两组:治疗(EN)组,术后第1天即开始行肠内高营养;对照(TPN)组,术后即给予全肠外营养,共9d。分别于术前及术后第1、5、9天,采静脉血,监测血浆中游离脂肪酸(C16:0、C18:0、C18:2、C20:4)。结果术前及术后d1两组无差异(P>0.05);d5、d9两组游离脂肪酸(FFA)均升高,C16:0、C20:4两组比较差异最明显(P<0.01);手术前后两组各自比较差异均有显著性(P<0.01)。结论手术创伤后血浆中游离脂肪酸浓度降低,术后EN能更快予以补充,并且优于TPN。     

核转录因子Sp1在手术创伤后腹膜组织中的活性改变与腹膜粘连形成关系探讨

目的探讨核转录因子Sp1在手术创伤后腹膜组织中的活性改变与腹膜粘连形成关系。方法选取直肠癌手术患者108例,分为正常腹膜组(开腹后第一时间将腹膜组织从切口左侧2.0 cm处锐性切取)和创伤腹膜组(手术后将腹膜组织从切口右侧2.0 cm处锐性切取),每组各54例。比较两组腹膜组织中Sp1活性,观察Sp1抑制性竞争实验、腹膜组织的胶原纤维变化。结果创伤腹膜组手术后30 min、1 h、2 h、3 h、4 h的Sp1活性逐渐升高(P<0.05),均显著高于正常腹膜组(P<0.05)。50倍未标记特异寡核苷酸完全抑制第3泳道,无条带;50倍未标记变异寡核苷酸未抑制第4泳道,较第1泳道、第2泳道有结合的特异性。结论核转录因子Sp1在手术创伤后腹膜组织中的活化会在一定程度上引发腹膜粘连形成。     

糖皮质激素应用于肝脏严重创伤中的效果评价

目的 探讨糖皮质激素在预防严重肝脏创伤后继发性损害中的作用。方法 以某院收治的19例创伤性肝损伤患者为研究对象，随机分成治疗组(用糖皮质激素)和对照组(未用糖皮质激素)，在用药前、后不同时期检测血清丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、白蛋白(ALb)和乳酸脱氢酶(LDH)，于术中及术后第2～3d(活检)取肝组织观察两组病理变化。结果 肝脏损伤早期两组ALT及LDH均升高，随时间延长治疗组明显下降，对照组则进一步升高；ALb虽在正常范围，但对照组呈下降趋势，而治疗组未下降；两组AST无明显变化。治疗组肝脏病理改变轻于对照组。结论 糖皮质激素应用于严重肝脏创伤治疗可减轻肝脏继发性损害，且表现出一定的时效关系。     

Evolution of Lipid Profile,Liver Function,and Pattern of Plasma Fatty Acids According to the Type of Lipid Emulsion Administered in Parenteral Nutrition in the Early Postoperative Period After Digestive Surgery

Background: The metabolic effects of intravenous lipid emulsions (ILEs) used in parenteral nutrition (PN) depend on their fatty acid composition. Methods: Subjects in this prospective and randomized double‐blind study were 28 adult patients post digestive surgery. PN was started after surgery and lasts for 5 days. Randomly, patients receive 1 of 4 different ILEs: medium‐chain triglycerides/long‐chain triglycerides (soybean oil; MCT/LCT), olive/soybean oil (oleic), long‐chain triglycerides (soybean oil; LCT), and structured lipid. On days 0 and 6, serum liver function tests were analyzed for cholesterol, triglycerides, lipoproteins, and serum fatty acids. Results: No differences were found in the 4 groups according to their gender, age, body mass index, diagnosis, baseline white blood cell, C‐reactive protein, glucose levels, and other study parameters. Differential significant changes were not observed in any of the hepatic function parameters or plasmatic lipid levels between the groups. A significant decrease was observed in cis monounsaturated fatty acids (MUFAs) and a significant increase in ω‐6 polyunsaturated fatty acids (PUFAs) andω ‐3 PUFA values in LCT and structured groups compared with MCT/LCT and oleic groups, and a tendency for a decrease in trans fatty acids in the oleic and structured groups was found. Conclusions: All ILEs administered were safe and well tolerated. The changes in serum fatty acids reflected the pattern of fatty acids administered with different ILEs. The group receiving the olive oil emulsion achieved a fatty acid composition of serum lipids that could offer major therapeutic or biological advantages.     

中长链脂肪酸食用油对高甘油三酯血症患者脂代谢的影响

目的探讨中长链脂肪酸食用油对高甘油三酯血症患者血脂的影响。方法将112名高甘油三酯血症患者分为2组,分别食用中长链脂肪酸食用油和长链脂肪酸食用油,指导每日运动量、热能和食用油摄入量(25～30g/d)。研究开始前和8w后对两组研究对象进行人体测量、血生化检测。结果有11人退出研究,中长链脂肪酸食用油和长链脂肪酸食用油组分别有51人和50人,两组间性别分布没有差别。研究前、第2、4、6、8w,两组间热能、蛋白质、脂肪、碳水化合物和体力活动时间也无差别。与研究前相比,食用中长链脂肪酸食用油8w后体重、BMI、腰围、臀围、腰臀比、体脂肪量、体脂肪百分比等人体测量指标明显降低,而且体重、BMI、腰围、体脂肪、体脂肪百分比降低的程度明显优于长链脂肪酸食用油组。中长链脂肪酸食用油组8w后TG、ApoB、ApoAII、ApoC2、ApoC3水平明显下降,且降低的程度均明显优于长链脂肪酸食用油组。结论合理膳食条件下,中长链脂肪酸食用油可减轻高甘油三酯血症患者体重,降低血甘油三酯水平,改善脂蛋白代谢。     

Cystine and Theanine as Stress-Reducing Amino Acids—Perioperative Use for Early Recovery after Surgical Stress

Perioperative nutritional therapy requires the consideration of metabolic changes, and it is desirable to reduce stress aiming at early metabolic normalization. Glutathione (GSH) is a tripeptide composed of glutamic acid, cysteine, and glycine. It is one of the strongest antioxidants in the body and important for adjusting immune function. Cystine and theanine (γ-glutamylethylamide) provide substrates of GSH, cysteine and glutamic acid, promoting the synthesis of GSH. It has been reported that the ingestion of cystine (700 mg) and theanine (280 mg) exhibits inhibitory effects against excess inflammation after strong exercise loads in athletes, based on which its application for invasive surgery has been tried. In patients undergoing gastrectomy, ingestion of cystine (700 mg) and theanine (280 mg) for 10 days from 5 days before surgery inhibited a postoperative increase in resting energy expenditure, promoted recovery from changes in interleukin-6, C-reactive protein, lymphocyte ratio, and granulocyte ratio and inhibited an increase in body temperature. In a mouse small intestine manipulation model, preoperative 5-day administration of cystine/theanine inhibited a postoperative decrease in GSH in the small intestine and promoted recovery from a decrease in behavior quantity. Based on the above, cystine/theanine reduces surgical stress, being useful for perioperative management as stress-reducing amino acids.