胃肠外营养对肝切除后肝脏再生的影响

TheInfluenceofParenteralNutritiononLiverRegenerationafterHepatectomy

目的：探讨胃肠外营养对肝脏再生的影响．方法：将大鼠随机分成４组：Ⅰ组不手术，自由摄食；Ⅱ组６５％肝切除后用１０％葡萄糖治疗；Ⅲ组术后用支链氨基酸强化的胃肠外营养治疗；Ⅳ组术后用标准胃肠外营养治疗．实验第三、六天观察肝脏再生反应．结果：Ⅱ组肝重、肝重／体重、肝脏再生率（ＲＬＲ）、肝细胞有丝分裂率（ＭＩ）和ＤＮＡ合成率明显降低，肝细胞脂肪变性和水样变性明显且伴有灶性坏死；Ⅲ、Ⅳ组ＲＬＲ、ＭＩ及ＤＮＡ合成率明显增加，肝细胞脂肪变性和水样变性减轻，其中Ⅲ组明显优于Ⅳ组．结论：肝切除后营养摄入不足抑制肝脏再生反应。

Aim:Thisstudywasdesignedtoinvestigatetheefectofparenteralnutrition(PN)onliverregenerationafter65%hepatectomy.Methods:Theratswerealocatedrandomlytooneoffourgroups(G):RatsinGⅠreceivedstandardchowadlibitumandweredevoidofhepatectomy;GⅡreceived10%glucoseparenteralyafter65%hepatecto-my;GⅢreceivedbranched-chainaminoacidenrichedPNafterliverresection;andGⅣreceivedstandardPNafterhepa-tectomy.Theresponseofliverregenerationwasinvestigatedonthethirdandsixthdayafterliverresection.Results:InGⅡ,theliverweight,hepaticmassindex,rateofliverregeneration(RLR)andDNAsynthesis,andmitoticindex(MI)weredecreasedsignificantly,andhepatocelularfataccumulationandhydropicdegenerationwerealsoveryobvi-ous,associatedwithhepatocytefocalnecrosis.InGⅢandⅣ,theRLR,MIandrateofDNAsynthesiswereincreasedsignificantly;andsteatosisandhydropicchangeoflivercelwerereducedobviously;andthevaluesinGⅢweresuperiorsignificantlytothatinGⅣ.Conclusion:Theinsuficiencyofnutrientsintakeinhibitstheresponseofliverregenerationafterhepatectomy,andappropriatePNcanenhancetheactivityofliverregeneration.