急性肝衰竭大鼠全营养液应用的实验研究

Application of total nutrient admixture in acute hepatic failure rats

目的探讨含30．6％支链氨基酸（BCAA）的复方氨基酸、中长链脂肪乳、葡萄糖、多种维生素和多种无机盐联合应用的全营养液对急性肝衰竭大鼠的治疗效果。方法将30只大鼠随机分为正常对照组（A组）、肝衰竭对照组（B组）、无脂肪营养液组（C组）和全营养液组（D组），应用D半乳糖胺制备急性肝衰竭模型。观察其肝功能、肾功能、氮平衡、血浆蛋白、氨基酸谱、肿瘤坏死因子、血糖、血脂的改变及淋巴细胞转化率。结果数据比较采用单因素方差分析、SNK-q检验或重复测量资料的方差分析。结果肝、肾功能各项指标以D组恢复较好。ALT、碱性磷酸酶、总胆红素、血尿素氮指标D组优于C组（F值分别为1．280、1．878、2．439和1．473，P值均〈0．05）。D组总蛋白、白蛋白、前白蛋白、氮平衡恢复较好，前白蛋白D组优于C组。D组血浆氨基酸谱恢复接近正常。D组血中肿瘤坏死因子含量高于C组（F=1．609，P〈0．05），D组刺激指数高于B组和C组（F值分别为2．648和1．432，P值均〈0．05）。D组与C组血糖差异有统计学意义（F=2．325，P〈0．05），B组与A、C、D组甘油三酯差异有统计学意义（F值分别为1．180、2．578和2．432，P值均〈0．05）；D组与B组胆固醇差异有统计学意义（F=2．125，P〈0．05）；脂质过氧化物各组间差异无统计学意义（F=3．507，P〉0．05）。结论大鼠急性肝衰竭后需要营养支持治疗的调整及营养底物的供给，结构比例合理的全营养液能使损伤的肝细胞得以再生，并促进合成代谢，有利于大鼠急性肝衰竭的逆转。

Objective To study the therapeutic efficacy of total nutrition admixture （TNA） containing 30.6% BCAA, MCT/LCT, glycose, vitamin, electrolytes in rat with acute hepatic failure （AHF）. Method 30 Wistar rats were randomly divided into 4 groups： Normal control, AHF control, Fat-free nutrient admixture group, TNA group. AHF model was induced by D-galactosamine Liver and renal function, nitrogen balance, plasma total protein, albumin, prealbumin, fibronectin, hemoglobin, aminogram, tumor necrosis factor, lymphocyte transformation rate, glucose, blood fat tests etc were determined. Results The improvement of liver and renal function was better in TNA group than those in other groups. ALT ALP TBil BUN were lower in TNA group than those in other groups. TP, ALB, PA, N-balance in TNA group were significantly higher than those in other groups. The spectrum of plasma amino acids of the TNA group was close to the normal and the control group. The TNF in TNA group were significantly higher than that in Fat-free nutrient admixture group. The stimulation index in TNA group was significantly higher than that in other groups. The difference of triglyeride in TNA group and normal diet was statistically significant, The difference of cholesterol in TNA group and Fat-free nutrient admixture was statistically significant, The difference of lipid peroxidation in four groups was not statistically significant. Conclusion Nutritional supportive treatment is necessary for AHF.