富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响

目的 观察富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响。方法 选择2019年6月～2021年6月因重型颅脑损伤术后进入某院重症医学科加强监护治疗的患者42名,随机分为对照组[肠内营养混悬液(SP,百普力组),n=20]和实验组[肠内营养乳剂组(TPF-T,瑞能),n=22)]两组,患者在进入重症医学科后立即抽血行降钙素原(PCT)、外周血淋巴细胞总数、IL-2、IL-6、IL-10等检查。两组患者均经空肠营养管进行早期肠内营养支持,然后在入科后第48 h、72 h、96 h、7 d复测相关指标。通过对比上述数据的变化来评估富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响。结果 在PCT的变化上,实验组与对照组无统计学差异(P>0.05)。在外周血淋巴细胞总数的变化上,实验组在进行肠内营养72h后明显高于对照组,差异具有统计学意义(P<0.05)。在IL-2、IL-6、IL-10的变化上,实验组在进行肠内营养96 h后明显低于对照组,差异具有统计学意义(P<0.05)。结论 富含ω-3多不饱和脂肪酸肠内营养制剂可能有助于降低重...     

添加鱼油的肠内营养制剂在重症患者应用的安全性和临床效益

重症患者由于各种因素可引起全身炎症反应以及免疫功能抑制,进而导致并发症发生率和死亡率增加。而ω-3多不饱和脂肪酸(omega-3 poly unsaturated fatty acids,ω-3 PUFA)是目前研究较多的营养素之一,具有抗炎和免疫调节特性,可能对重症患者有益。鱼油作为ω-3 PUFA最主要的来源,目前在重症患者治疗中得到广泛应用,但其剂量相关的安全性和临床效益仍不明确,本文通过检索目前已发表的相关文献,基于循证医学证据对此问题进行了分析。结果发现,由于既往各项研究的对象及其代谢状态所存在的差异,在重者患者中应用补充鱼油的肠内营养制剂其安全性和临床效益等方面很难得出一致结论,还需要更多的高质量证据进一步验证。     

鱼油脂肪乳对直肠癌患者术后免疫功能的影响

目的 探讨鱼油脂肪乳在直肠癌患者术后肠外营养支持治疗中的应用价值.方法 选取医院2020年4月至7月收治拟行根治手术的直肠癌患者60例,按信封法分为试验组和对照组,各30例.两组患者术后均予短期肠外营养支持治疗,采用常规的营养方案,试验组患者加用10％ ω-3鱼油脂肪乳,持续5 d.两组患者术后第1,3,5天凌晨分别抽...     

结肠癌根治术围手术期应用ω-3多不饱和脂肪酸对患者免疫及术后炎性反应的影响

目的探究结肠癌根治术围手术期应用ω-3多不饱和脂肪酸对患者免疫及术后炎性反应的影响。方法选取2014年12月~2016年12月间在本院行结肠癌根治术患者68例进行前瞻性研究,按照随机分组原则分为两组,对照组34例在术后第1天予以PN支持(胃肠外营养),持续1周,观察组34例在对照组基础上联合ω-3多不饱和脂肪酸,统计分析组间营养状况、免疫指标、炎性反应及不良反应和术后并发症。结果术后观察组ALB、TP高于对照组,TF低于对照组,组间差异有统计学意义(P<0.05);术后观察组CD3~+、CD4~+及CD4~+/CD8~+水平显著高于对照组,差异有统计学意义(P<0.05);术后第2天两组患者TNF-α、IL-6及PCT显著升高,术后第7天开始下降,且观察组术后7d TNF-α、IL-6水平均显著低于对照组;组间PN不良反应及术后并发症比较,观察组低于对照组,组间差异有统计学意义(P<0.05)。结论结肠癌根治术患者围手术期予以ω-3多不饱和脂肪酸,可有效抑制炎症反应,改善营养状况,提高免功能,避免胃肠外营养不良反应和并发症。     

精氨酸对外科重症患者营养和免疫的影响

目的：探讨精氨酸对外科重症患者营养和免疫的影响。方法收集32例外科重症患者,随机分为精氨酸组（n=16例）和对照组（n=16例）,精氨酸组患者在常规营养支持基础上静脉给予精氨酸20g/d,连用7d。治疗第1d与第8d分别抽血检测营养指标（血清白蛋白、前白蛋白）、细胞免疫指标（CD3＋、CD4＋）、体液免疫指标（IgA、IgG、IgM）。结果精氨酸组患者第8d血清白蛋白、前白蛋白、CD3＋、CD4＋、IgG、IgM均较第1d明显升高（P〈0.05）,对照组患者仅第8d血清前白蛋白均较第1d明显升高（P〈0.05）。两组患者白蛋白、IgA升高程度比较,差异无统计学意义（P〉0.05）;前白蛋白、CD3＋、CD4＋、IgG、IgM升高程度比较,差异有统计学意义（P〈0.05）。结论添加精氨酸的营养支持能有效提高外科重症患者免疫应答水平,改善营养状况。     

ω-3和ω-6多不饱和脂肪酸对血脂代谢影响及相关机制

血脂异常与心脑血管系统疾病的发生密切相关,其主要发病机制是造成动脉粥样硬化。临床多项循证医学证据表明,高胆同醇血症尤其是LDL—C的升高是造成动脉粥样硬化的独立危险因素之一。此外,高脂血症也是高血压、糖耐量异常、糖尿病、缺血性脑卒中等疾病的一个重要危险因素。     

免疫营养对外科脓毒症的治疗研究

目的研究免疫营养对外科脓毒症患者APACHEⅡ评分的影响。方法将40例外科脓毒症患者随机分成研究组和对照组,各20例。研究组为免疫营养组,对照组为常规营养组。两组均给予常规外科治疗,并于术后第1d开始给予静脉营养治疗7d,其中研究组静脉应用谷氨酰胺,比较两组APACHEⅡ评分的变化。结果两组治疗后APACHEⅡ评分均下降,研究组较对照组下降更为明显(P<0.05)。结论谷氨酰胺增强的肠外营养能减轻外科脓毒症患者病情的危重程度,改善预后。     

术前口服肠内免疫营养在食管癌新辅助化疗 患者中的临床应用

摘要：目的 观察术前肠内免疫营养对食管癌新辅助化疗患者营养状态、免疫状况及临床结局的影响。方法 选取行食管癌切除手术的患者65例,按随机表分为肠内免疫营养组（EIN组,34例）和常规饮食组（对照组,31例）。 所有入组患者术前均行新辅助化疗2周期,并于新辅助化疗结束后3～4周行食管癌根治术。EIN组于新辅助化疗第 2疗程结束后1周开始在常规饮食基础上口服肠内免疫营养,直至术前1 d。对照组于新辅助化疗第2疗程结束后只 给予常规饮食。观察2组患者新辅助化疗第2疗程结束后1周及术前1 d的体质量指数、肱三头肌皮皱厚度和上臂 围。观察2组患者新辅助化疗第2疗程结束后1周、术前1 d、术后1 d、术后1周的营养及免疫指标。观察2组患者术 后1 d下床活动时间完成例数、术后首次肛门排气时间、术后肠内营养相关不良反应发生例数、术后肺炎发生例数和 住院时间。结果 2组患者在性别、年龄、吸烟史、饮酒史、临床分期、肿瘤位置等方面比较差异无统计学意义（P＞ 0.05）。术前1 d EIN组的体质量指数、肱三头肌皮皱厚度和上臂围与对照组相比差异有统计学意义（均P＜0.05）。 术前1 d EIN组营养指标和免疫指标显著上升（P＜0.05）;术后1 d 2组各营养指标和免疫指标均明显下降,与术前1 d 相比差异有统计学意义（P＜0.05）;术后1周2组患者各指标较术后1 d显著上升（P＜0.05）。术后1周2组指标和免 疫指标相比差异有统计学意义（P＜0.05）。术后下床活动完成例数EIN组较对照组明显增多,术后肠内营养相关不 良反应（腹胀、腹泻）及肺炎并发症例数EIN组较对照组少,术后首次排气时间和住院时间EIN组比对照组均较短,差 异有统计学意义（P＜0.05）。结论 对于食管癌新辅助化疗患者,术前口服肠内免疫营养,能改善患者的营养状态和 免疫状况,增加患者对手术的耐受力,降低并发症的发生,促进患者的快速康复。     

谷氨酰胺作为免疫营养药物的机制探讨

<正>某些营养物质不仅能防治营养缺乏,而且能以特定的方式刺激免疫细胞增强应答功能,维持适度的炎症反应,调控细胞因子的产生和释放,减轻有害过度的炎症反应,维持肠屏障功能,称为免疫营养。如谷氨酰胺(Gln),精氨酸ω-3多不饱和脂肪酸,膳食纤维等。本文重点讨论谷氨酰胺作为免疫营养药物的机制。1 GLn是5碳氨基酸,是微循环和体内氨基酸池中含量最丰富的氨基酸     

Combination of arginine and omega-3 fatty acids enteral nutrition in critically ill and surgical patients: a meta-analysis

Immunonutrients may improve outcomes in critically ill and surgical patients. The objective of this meta-analysis was to determine if the combination of arginine and omega-3 fatty acids impacts infection rate, hospital length of stay and mortality in critically ill or surgical patients. In total, 23 studies met all of the criteria. Immunonutrition with arginine and omega-3 fatty acids was administered either pre- or post-operatively or during intensive care unit stay in seven, ten and six studies, respectively. Infection rate and length of stay were significantly lower in patients receiving immunonutrition compared with the control group. In a subgroup analysis, these differences were maintained in the pre- and post-operative populations, but were not significant in the critically ill population. Mortality was not significantly different between the immunonutrition and control groups.     

The induction of apoptosis in pre-malignant keratinocytes by omega-3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) is inhibited by albumin

The long chain omega-3 polyunsaturated fatty acids (PUFA) have been reported to exert anti-cancer effects. At this study we tested the effect of the omega-3 PUFA, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), on pre-malignant keratinocytes growth in the well-characterised human pre-malignant epidermal cell line, HaCaT and attempted to identify a PUFA serum antagonist. Both EPA and DHA inhibited HaCaT growth and induced apoptosis. At the 10% (v/v) foetal bovine serum (FBS) medium, limited growth inhibition (3–20% for 50 μM DHA and EPA respectively) and negligible apoptosis were observed with PUFA use. However, at 3% (v/v) FBS medium, 30–50 μM of PUFA caused impressive levels of growth inhibition (82–83% for 50 μM DHA and EPA respectively) and increase of apoptosis (8–19% increase in 72 h). None of the numerous serum growth factors present in FBS or the antioxidant n-tert-butyl-α-phenylnitrone could inhibit the PUFA-induced cytotoxicity. In contrast, bovine and human albumin (0.1–0.3%, w/v) significantly antagonized the growth inhibitory and apoptosis-inducing effects of PUFA. In conclusion, we have shown for the first time that omega-3 PUFA inhibit the growth and induce apoptosis of pre-malignant keratinocytes and identified albumin as a major antagonistic factor in serum that could limit their effectiveness at pharmacologically-achievable doses.     

ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用的研究

目的 观察ω-3多不饱和脂肪酸在严重脓毒症机械通气早期的保护作用.方法 将32例严重脓毒症机械通气的患者随机分为对照组（17例）和治疗组（15例）.使用等氮、等热量肠内及肠外混合营养共5 d,热量为113 kJ（27 kcal）/（kg·d）.对照组病人用中长链脂肪乳剂,研究组病人用ω-3鱼油脂肪乳＋中长链脂肪乳剂.分别在试验开始前和试验第6天早晨,抽血检测白细胞数、总蛋白、白蛋白、MDA、血浆C反应蛋白、血气分析指标（动脉氧分压、动脉二氧化碳分压氧合指数）,同时记录患者临床体征（心率、呼吸、体温）及进行APACHEⅡ评分.结果 添加鱼油脂肪乳的患者呼吸情况（17.13±3.78）次/分、氧合情况（251.27±52.68）、CRP（46.13±25.33）及APACHEⅡ评分（ 14±3.67）分及MDA（7.95±2.48）分,较对照组明显改善（P〈0.05）.结论 ω-3多不饱和脂肪酸在严重脓毒症机械通气患者早期应用可以降低患者体内过渡的炎症反应,减少氧化应激产物的生成,改善患者的氧合情况.     

肠内免疫营养剂在胃癌术后临床研究

目的探讨胃癌术后应用免疫肠内营养剂对患者营养、免疫功能的影响。方法将68例胃癌术后患者随机分为对照组(标准肠内营养组,n=34)和试验组(肠内免疫营养组,n=34)。比较两组患者术后治疗后营养状况、免疫功能情况。结果试验组在提高术后营养、免疫功能、纠正负氮平衡方面较对照组有效(P<0.05)。结论胃癌患者术后应用肠内免疫营养对蛋白质合成及免疫功能恢复疗效明显,值得临床推广。     

Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients

Background

Anemia is a common complication among hemodialysis (HD) patients. Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment, about 10% of HD patients show suboptimal response to these agents. Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness. Considering the anti-inflammatory properties of omega-3 fatty acids, this study aimed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients.

Methods

In this randomized, placebo-controlled trial, 54 adult patients with HD duration of at least 3 months were randomized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months. Anemia parameters including blood hemoglobin, serum iron, transferrin saturation (TSAT), erythropoietin resistance index, and required dose of intravenous iron and erythropoietin, and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, C-reactive protein (CRP), hepcidin, ferritin, intact parathyroid hormone (iPTH), and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention.

Results

45 subjects (25 in the omega-3 and 20 in the placebo group) completed the study. No significant changes were observed in blood hemoglobin, serum iron, TSAT, and required dose of intravenous iron in either within or between group comparisons. Additionally, erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group. Although a relative alleviation in inflammatory state appeared in the omega-3 group, the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment (P <0.001 and P = 0.003, respectively).

Conclusion

Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia. However, future well-designed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia.     

辛伐他汀加用Omega-3脂肪酸对混合性血脂异常患者高敏C反应蛋白、血脂及纤溶的影响

目的:评价辛伐他汀加用Omega-3脂肪酸对冠心病及冠心病等危症合并混合性血脂异常患者高敏C反应蛋白(HsCRP)、血脂及纤溶的影响.方法:采用随机、双盲、安慰剂平行对照方法,40例冠心病及冠心病等危症合并混合性血脂异常患者经6～12周辛伐他汀10mg或20mg治疗后,分为试验组(n=20)和对照组(n=20),分别加用Omega-3脂肪酸3g*d-1或安慰剂,治疗2个月,观察治疗前后对HsCRP、血脂及纤溶的影响.结果:试验组治疗后HsCRP、三酰甘油(TG)、总胆固醇(TC)、TC/高密度脂蛋白胆固醇(HDL-C)较基线分别降低(2.16±2.77)(38.5%),(94.0±65.4)(31.1%),(13.3±22.3)mmol*L-1(6.3%)和(0.78±1.60)mg*dL-1(P分别<0.01,<0.001,<0.05,<0.05),对照组HsCRP及TG降低更为显著(P分别为0.021及0.011).试验组TG降低的数值及百分数分别与HsCRP降低的数值及百分数呈显著正相关(r分别为0.51和0.45,P分别为0.021和0.047).结论:辛伐他汀加用Omega-3脂肪酸增加二者的调脂优势和非调脂优势.     

Benefits and risks of fish consumption Part II. RIBEPEIX, a computer program to optimize the balance between the intake of omega-3 fatty acids and chemical contaminants

In recent years, and based on the importance of fish as a part of a healthy diet, there has been a notable promotion of fish and seafood consumption. However, a number of recent studies have shown that fish may be a potential source of exposure to chemical pollutants, some of them with well known adverse effects on human health. Recently, we determined in 14 edible marine species the concentrations of eicosapentaenoic acid (EPA) and docosohexaenoic acid (DHA), as well as those of a number of chemical contaminants: Cd, Hg, Pb, polychlorinated dibenzo-p-dioxins and furans, polychlorinated biphenyls, hexachlorobenzene, polycyclic aromatic hydrocarbons, polychlorinated naphthalenes, polybrominated diphenylethers and polychlorinated diphenylethers. To quantitative establish the intake of these pollutants (risks) versus that of EPA + DHA (benefits), we designed a simple computer program, RIBEPEIX. The concentrations of EPA, DHA, and the chemical pollutants were introduced into the program. We here present how RIBEPEIX may be used as an easy tool to optimize fish consumption: most suitable species, frequency of consumption, and size of meals. RIBEPEIX can be useful not only for professionals (cardiologists, general physicians, nutritionists, toxicologists, etc.), but also for the general population. It is available at: http://www.fmcs.urv.cat/portada/ribepeix/.     

Apoptotic activity of the marine diatom Cocconeis scutellum and eicosapentaenoic acid in BT20 cells

Context: The marine diatoms Cocconeis scutellum Ehrenberg (Bacillariophyceae) are known to trigger apoptosis in the androgenic gland of the Mediterranean crustacean Hippolyte inermis Leach (Decapoda), affecting the shrimp’s sex reversal.

Objective: The aim of this study was to evaluate a possible apoptotic effect of extracts and fractions from these microalgae also on human tissues.

Materials and methods: The chemical profile of C. scutellum was determined by gas chromatography-mass spectrometry (GC-MS) and, afterwards, organic extracts and fractions from the diatoms were used to treat to breast cancer BT20 cells. Double labeling with annexin V-FITC and isotonic propidium iodide (PI) along with flow cytometry analysis enabled the evaluate of cell apoptosis and viability, whereas hypotonic PI staining was used to analyze the cell cycle in BT20 lines. The involvement of specific caspases was studied by Western blotting.

Results: Results demonstrated that the diethyl ether extract and, in particular, fraction 3, the richest fraction in eicosapentaenoic acid (EPA) from the diethyl ether extract, selectively induced apoptosis (up to 89.2% at 1 μg/well of fraction 3) and decreased viability in BT20 cells. The apoptotic effect was displayed in a concentration and time-dependent manner, by activating caspases-8 and 3, and arresting the progression of the cell cycle from S to G2-M phase. EPA alone showed similar apoptotic effects in BT20 cells.

Discussion and conclusion: The study demonstrates the apoptotic activity of C. scutellum diatoms on breast cancer cells and suggests their potential use as a source of apoptotic compounds.     

Benefits and risks of fish consumption Part I. A quantitative analysis of the intake of omega-3 fatty acids and chemical contaminants

In recent years, and based on the importance of fish as a part of a healthy diet, there has been a notable promotion of fish consumption. However, the balance between health benefits and risks, due to the intake of chemical contaminants, is not well characterized. In the present study, edible samples of 14 marine species were analyzed for the concentrations of omega-3 fatty acids, as well as a number of metals and organic pollutants. Daily intakes were specifically determined for a standard adult of 70 kg, and compared with the tolerable/admissible intakes of the pollutants, if available. Salmon, mackerel, and red mullet were the species showing the highest content of omega-3 fatty acids. The daily intakes of cadmium, lead, and mercury through fish consumption were 1.1, 2.0, and 9.9 μg, respectively. Dioxins and furans plus dioxin-like polychlorinated biphenyls (PCBs) intake was 38.0 pg WHO-TEQ/day, whereas those of polybrominated diphenyl ethers (PBDEs), polychlorinated diphenyl ethers (PCDEs), polychlorinated naphthalenes (PCNs) and hexachlorobenzene (HCB) were 20.8, 39.4, 1.53, and 1.50 ng/day, respectively. In turn, the total intake of 16 analyzed polycyclic aromatic hydrocarbons (PAHs) was 268 ng/day. The monthly fish consumption limits for human health endpoints based on the intake of these chemical contaminants were calculated for a 70 years exposure. In general terms, most marine species here analyzed should not mean adverse health effects for the consumers. However, the type of fish, the frequency of consumption, and the meal size are essential issues for the balance of the health benefits and risks of regular fish consumption.