中、长链脂肪乳剂对肝硬变家兔胆红素代谢及肝功能的影响

Effect of Long and Medium-chain Triglyceride-enriched Total Parenteral Nutrition on Bilirubin Metabolism and Liver Function in Cirrhotic Rabbits

研究长链脂肪乳剂和中/长链混合脂肪乳剂二种不同肠外营养液支持下,观察血中游离脂肪酸浓度变化对胆红素和肝功能的影响。方法:21只新西兰大白兔经结扎胆总管制成胆源性肝硬化动物模型,随机分为三组:正常对照组(n=6);肝硬化肠外营养PN-LCT组(n=10);肝硬化肠外营养PN-MCT/LCT组(n=11)。两组的PN液所含热量及氮量均相等。在PN的第1、7天,用高效液相色谱(HPLC)测定PN后4h血中游离脂肪酸(FFA)浓度,并常规测定胆红素及白蛋白和肝脏酶学的变化。结果:肝硬变形成后,总胆红素及直接胆红素、丙氨酸转氨酶(ALT)、天门东氨酸转氨酶、碱性磷酸酶、γ-谷酰转肽酶均明显升高,而白蛋白明显下降,P<0.01。PN期间,FFA及FFA/白蛋白比值也明显升高,P<0.01。PN第7天时,LCT组直接胆红素及ALT和FFA/白蛋白比值均明显高于MCT/LCT组,P<0.01。结论:MCT/LCT乳剂可能是应用于肝硬变兔更为理想的能量来源。

Aims:To study the effect of long and medium-chain triglyceride enriched TPN on bilirubin metabolism and liver function by measuring the serum fatty acid level. Methods: Rabbits with cirrhosis, induced by ligating common bile duct, were divided into three groups randomly, namely: normal, LCT-PN and MCT/LCT group. Serum free fatty acid(FFA) was measured by HPLC, and bilirubin, albumin and liver enzymes were measured. Results: It showed that TBil, DBil, ALT, AST, AKP, **-GT markedly increased in cirrhotic rabbits, and albumin markedly decreased (P<0.01). After PN 7 days, ALT, FFA and FFA/Alb in group LCT were higher than that in group MCT/LCT. Conclusion: It is indicated that intravenous lipid emulsion containing MCT is an ideal nutritional source for the cirrhotic patients.