摘要
AIM:To investigate the liver-protecting effect of parenteral nutrition(PN) support with omega-3 fatty acids in a randomized controlled clinical trial.METHODS:Sixty-six patients with the diagnosis of end-stage liver disease or hepatic cellular carcinoma were admitted to the Affiliated Drum Tower Hospital,Nanjing University,China for orthotopic liver transplantation.The patients were randomly divided into two groups:PN group(n = 33) and polyunsaturated fatty acid(PUFA) group(n = 33).All patients received isocaloric and isonitrogenous PN for seven days after surgery,and in PUFA group omega-3 fish oil lipid emulsion replaced part of the standard lipid emulsion.Liver function was tested on days 2 and 9 after surgery.Pathological examination was performed after reperfusion of the donor liver and on day 9.Clinical outcome was assessed based on the post-transplant investigations,including:(1) post-transplant mechanical ventilation;(2) total hospital stay;(3) infectious morbidities;(4) acute and chronic rejection;and(5) mortality(intensive care unit mortality,hospital mortality,28-d mortality,and survival at a one-year post-transplant surveillance period).RESULTS:On days 2 and 9 after operation,a significant decrease of alanine aminotransferase(299.16 U/L ± 189.17 U/L vs 246.16 U/L ± 175.21 U/L,P = 0.024) and prothrombin time(5.64 s ± 2.06 svs 2.54 s ± 1.15 s,P = 0.035) was seen in PUFA group compared with PN group.The pathological results showed that omega-3 fatty acid supplement improved the injury of hepatic cells.Compared with PN group,there was a significant decrease of post-transplant hospital stay in PUFA group(18.7 d ± 4.0 d vs 20.6 d ± 4.6 d,P = 0.041).Complications of infection occurred in 6 cases of PN group(2 cases of pneumonia,3 cases of intra-abdominal abscess and 1 case of urinary tract infection),and in 3 cases of PUFA group(2 cases of pneumonia and 1 case of intra-abdominal abscess).No acute or chronic rejection and hospital mortality were found in both groups.The one-year mortality in PN group was 9.1%(3/33),one died of pulmonary infection,one died of severe intra-hepatic cholangitis and hepatic dysfunction and the other died of hepatic cell carcinoma recurrence.Only one patient in PUFA group(1/33,3.1%) died of biliary complication and hepatic dysfunction during follow-up.CONCLUSION:Post-transplant parenteral nutritional support combined with omega-3 fatty acids can significantly improve the liver injury,reduce the infectious morbidities,and shorten the post-transplant hospital stay.
AIM：To investigate the liver-protecting effect of parenteral nutrition（PN） support with omega-3 fatty acids in a randomized controlled clinical trial.METHODS：Sixty-six patients with the diagnosis of end-stage liver disease or hepatic cellular carcinoma were admitted to the Affiliated Drum Tower Hospital,Nanjing University,China for orthotopic liver transplantation.The patients were randomly divided into two groups：PN group（n = 33） and polyunsaturated fatty acid（PUFA） group（n = 33）.All patients received isocaloric and isonitrogenous PN for seven days after surgery,and in PUFA group omega-3 fish oil lipid emulsion replaced part of the standard lipid emulsion.Liver function was tested on days 2 and 9 after surgery.Pathological examination was performed after reperfusion of the donor liver and on day 9.Clinical outcome was assessed based on the post-transplant investigations,including：（1） post-transplant mechanical ventilation;（2） total hospital stay;（3） infectious morbidities;（4） acute and chronic rejection;and（5） mortality（intensive care unit mortality,hospital mortality,28-d mortality,and survival at a one-year post-transplant surveillance period）.RESULTS：On days 2 and 9 after operation,a significant decrease of alanine aminotransferase（299.16 U/L ± 189.17 U/L vs 246.16 U/L ± 175.21 U/L,P = 0.024） and prothrombin time（5.64 s ± 2.06 svs 2.54 s ± 1.15 s,P = 0.035） was seen in PUFA group compared with PN group.The pathological results showed that omega-3 fatty acid supplement improved the injury of hepatic cells.Compared with PN group,there was a significant decrease of post-transplant hospital stay in PUFA group（18.7 d ± 4.0 d vs 20.6 d ± 4.6 d,P = 0.041）.Complications of infection occurred in 6 cases of PN group（2 cases of pneumonia,3 cases of intra-abdominal abscess and 1 case of urinary tract infection）,and in 3 cases of PUFA group（2 cases of pneumonia and 1 case of intra-abdominal abscess）.No acute or chronic rejection and hospital mortality were found in both groups.The one-year mortality in PN group was 9.1%（3/33）,one died of pulmonary infection,one died of severe intra-hepatic cholangitis and hepatic dysfunction and the other died of hepatic cell carcinoma recurrence.Only one patient in PUFA group（1/33,3.1%） died of biliary complication and hepatic dysfunction during follow-up.CONCLUSION：Post-transplant parenteral nutritional support combined with omega-3 fatty acids can significantly improve the liver injury,reduce the infectious morbidities,and shorten the post-transplant hospital stay.
基金
Supported by Grants From Jiangsu Provincial Government,China,No. ZX200605
