结构脂肪乳对肝硬化患者氮平衡及蛋白质代谢的影响

Effects of structured triglycerides on nitrogen balance and protein metabolism in liver cirrhosis patients

目的比较结构脂肪乳（STG）和中长链脂肪乳（MCT/LCT）对肝硬化患者氮平衡及蛋白质代谢的影响,进一步评估STG的临床疗效。方法纳入解放军105医院消化内科2010年3-10月被诊断为肝硬化的患者26例,分为STG组（17例）和MCT/LCT组（9例,MCT与LCT物理混合）。两组患者于住院后第1~6天接受肠外营养,根据体重计算患者每日所需营养支持量。对比观察两组患者氮平衡、肝脏酶学指标（ALT、AST、TBIL）、血浆蛋白质[前白蛋白（PA）、白蛋白（ALB）]水平及临床营养测量指标。结果治疗过程中,有3例患者退出,其中STG组2例,MCT/LCT组1例。两组患者临床特征无统计学差异（P〉0.05）。在进行6d的肠外营养后,STG组（6.4±2.1g）患者累积氮平衡值明显高于MCT/LCT组（2.8±2.3g,P〈0.05）;两组患者PA和ALB水平均较治疗第1天上升（P﹤0.05）;两组肝脏酶学指标及血浆蛋白质水平与治疗第1天比较均无统计学差异（P〉0.05）;临床营养测量指标三头肌皮褶厚度和上臂肌围与治疗第1天比较无明显差异,两组之间亦无明显差异（P〉0.05）。结论 STG比MCT/LCT具有更好的氮平衡,能有效改善蛋白质代谢,促进肝硬化患者的恢复。

Objective This study aims to compare the effects of structured triglyceride lipid emulsion（STG） and medium-and long-chain triglyceride lipid emulsion（MCT/LCT） on nitrogen balance and protein metabolism in cirrhotic patients,and to further evaluate the clinical efficacy of STG.Methods A total of 26 cirrhotic patients admitted from Aug.2010 to Aug.2011 in the 105 Hospital of People＇s Liberation Army were divided into the STG group（17 cases） and MCT/LCT group（9 cases）.The patients of both groups received parenteral alimentation 1 to 6d after hospitalization.Each patient＇s daily nutritional support was calculated according to bady weight.Nitrogen balance,liver enzyme indicators（ALT,AST,and TBIL）,plasma protein（PA and ALB）,and the measurement index of clinical nutrition were compared between two groups.Results During the treatment period,three patients quit： two from the STG group and one from the MCT/LCT group.There was no statistical difference in the clinical features between the patients in these two groups（P0.05）.After 6 d of parenteral alimentation,the cumulative nitrogen balance of patients in the STG group（6.4±2.1g） was notably higher than that of patients in the MCT/LCT group（2.8±2.3g,P0.05）.The PA and ALB levels of both groups were higher than those on the first day（P0.05）.Liver enzyme indicators and plasma protein levels exhibited no statistical difference compared with those from the first day（P0.05）.The measurement index of clinical nutrition,which included the thickness of triceps skinfold and arm muscle circumference,had no obvious difference comparing with that on the first day.There was no obvious difference between two groups（P0.05）.Conclusion Compared with MCT/LCT,STG seems to give better nitrogen balance.Furthermore,STG can effectively improve protein metabolism and help cirrhotic patients recover more quickly.