早期肠内肠外营养支持对肝硬化大鼠肝切除术后的影响

Effects of early postoperative enteral and parenteral nutrition support in cirrhotic rats after partial hepatectomy

目的 观察早期肠内肠外营养支持对肝硬化大鼠肝部分切除术后的影响.方法 采用24只雄性SD大鼠随机分为3组：A组正常大鼠肠内营养;B组肝硬化大鼠肠内营养;C组肝硬化大鼠肠外营养.3组大鼠行肝部分切除术后1 d分别进行等热量[690 kJ/（kg·d）]等氮量[1.22g/（kg·d）]营养支持,共5 d.术后6 d测定大鼠体质量、肝功能、前白蛋白、转铁蛋白、肝组织白蛋白（ALB）mRNA的表达及细胞增殖核抗原（Ki-67）蛋白表达水平.结果 与术前比较,术后A组大鼠体质量增加,B、C组体质量减轻,差异有统计学意义[A：（6.16±3.28）g;B：（5.46±2.59）g;C：（6.13±3.21）g,P＜0.05）.术后B、C组大鼠肝功能与A组比较,血清AST、ALT、ALP升高,ALB降低,差异均有统计学意义（P＜0.05）;B组与C组比较,ALP升高,差异有统计学意义[B：（209±81）IU/L;C：（271：±92）IU/L,P＜0.05）.术后B、C组大鼠血清前白蛋白和转铁蛋白与A组比较均降低,差异有统计学意义（P＜0.05）;C组与B组比较,血清前白蛋白降低,差异有统计学意义[B：（161±37）mg/L;C：（133±29）mg/L,P＜0.05].术后B、C组肝组织ALB mRNA表达水平比A组下降,差异有统计学意义（A：1.46±0.12;B：1. 07±0.14;C：0.84±0.18,P＜0.05）;B组与C组比较,C组肝组织ALB mRNA表达水平降低,差异有统计学意义（P＜0.05）.术后A组肝组织Ki-67蛋白表达指数比B、C组高,差异有统计学意义（A：8.90±0.45;B：5.60±0.34;C：3.80±0.21,P＜0.05）;而B组Ki-67指数比C组高,差异有统计学意义（P＜0.05）.结论 肝硬化大鼠肝部分切除术后存在明显的肝功能不全和肝再生能力下降,虽经过积极的肠内或肠外营养支持,其术后各项指标的恢复均明显差于无肝硬化的大鼠.肠内营养较肠外营养更能促进肝硬化大鼠肝部分切除术后肝脏蛋白质的合成代谢和肝再生,肠内营养途径可进一步降低与肠外营养相关的胆汁淤积并发症的发生.

Objective To evaluate the impact of early enteral and parenteral nutrition support in rats with liver cirrhosis after partial hepatectomy. Methods Twenty-four rats were randomly divided into three groups in this prospective randomized control study. From postoperative day （ POD） 1 to 5, all of these groups （group A, normal EN; group B, cirrhotic EN; group C, cirrhotic PN） after receiving partial hepatectomy were nutritionally supported with equal amount of calorie [690 kj/（kg·d）] and nitrogen [1.22 g/（kg·d）] content. Moreover, on the POD 6, parameters like weight, liver function, prealbumin and transferrin were tested, as well as level of liver albumin mRNA detected by reverse transcription-poly-merase chain reaction （RT-PCR） and morphological examinations, like HE stain and immunohistochemical stain assessed by index of Ki-67 protein. Results Compared with the preoperative baseline on the POD 6, group A gained weight, but not in the other groups [group A; （6.16 ±3.28） g; group B： （5.46 ±3.59） g; groupC; （6.13 ±3.21） g,P〈0.05]. The levels of serum AST, ALT and ALP after partial hepatectomy were significantly higher in groups B and C than in group A （P 〈0.05）. Serum level of ALP was higher in group C （271 ±92） IU/L than in group B [ （209 ± 81） IU/L.P 〈0.05 ]. Levels of serum prealbumin and transferring were significantly declined after partial hepatectomy in groups B and C as compared with group A （P〈0.05）. The levels of prealbumin were significantly higher in group B （161 ±37） mg/L than in group C [ （133 ±29） mg/L.P 〈0.05 ]. The levels of albumin mRNA and index of Ki-67 in the murine liver were compared among these groups. Albumin mRNA was suppressed in groups B and C as compared with group A, as well as that in group C as compared with group B （A： 1.46 ±0.12; B： 1.07 ±0.14; C; 0.84 ± 0.18, P 〈 0.05）. Index of Ki-67 was higher in group A than in groups B and C, as well as that in group B than in group C （A： 8.90 ±0.45; B： 5.60 ±0.34; C： 3.80 ±0.21 ,P 〈0.05）. Conclusion Active nutrition support, through EN nor PN cannot efficiently promote liver regeneration and relieve liver malfunction in cirrhotic rats rather than in normal ones after partial hepatectomy, represented by delayed restoration of various parameters reflecting liver function. Nevertheless, compared with PN, standard EN revealed some advantages though. Besides reducing risk of PN-related cholestasis, EN can better the restoration by promoting protein synthesis and tissue regeneration in the postoperative liver.