ω-3多不饱和脂肪酸对重症急性胰腺炎患者肠黏膜屏障功能的影响

Effect of ω-3 polyunsaturated fatty acids on intestinal mucosal barrier of patients with severe acute pancreatitis

目的 研究ω-3多不饱和脂肪酸对重症急性胰腺炎（SAP）患者血清中D-乳酸水平、二胺氧化酶（DAO）活性和尿中乳果糖/甘露醇（L/M）比值的影响.方法 选取2012年8月至2014年5月山西医科大学第一医院普外科和河南省郸城县人民医院普外科SAP患者40例,采用SAS 8.0统计软件编程随机分为研究组（n=20）和对照组（n=20）,对照组给予常规肠外营养（PN）支持,研究组应用鱼油脂肪乳制剂（富含ω-3多不饱和脂肪酸）替代结构脂肪乳制剂.分别于入院当天及营养支持后第1、5、10天抽取静脉血检测D-乳酸水平和DAO活性,留取尿液检测L/M.结果 两组患者PN后血中D-乳酸水平、DAO活性及尿中L/M比值均有不同程度降低.入院当天及营养支持后第1天,研究组与对照组D-乳酸水平[（7.47±0.72）mg/L比（7.31±0.54） mg/L,F=0.677,P=0.416; （7.37 ±0.68） mg/L比（7.35±0.59） mg/L,F=0.014,P=0.908]、DAO活性[（16.99±0.93） U/L比（16.83±0.82） U/L,F=0.314,P=0.579; （17.12±0.77） U/L比（17.07±0.68） U/L,F=0.068,P=0.796]及尿L/M比值（0.23±0.07比0.22±0.07,F=0.091,P=0.765;0.21 ±0.07比0.22±0.08,F=0.119,P=0.732）的差异均无统计学意义.营养支持后第5天和第10天,研究组与对照组比较,D-乳酸水平[（5.62±0.34） mg/L比（6.61±0.30） mg/L,F=95.242,P=0.000;（2.76±0.55） mg/L比（4.56 ±0.37） mg/L,F=148.052,P=0.000]、DAO活性[（7.02±0.93） U/L比（10.40±0.68） U/L,F=170.815,P=0.000; （3.32 ±0.80） U/L比（6.09±0.69） U/L,F=138.645,P=0.000]和尿L/M比值（0.57±0.08比0.82±0.07,F=112.668,P=0.000;0.19 ±0.12比0.27±0.08,F=6.551,P=0.015）显著降低.结论 临床应用富含ω-3多不饱和脂肪酸的鱼油制剂治疗SAP,可明显降低血中D-乳酸水平、DAO活性及尿L/M比值,提示ω-3多不饱和脂肪酸可保护肠黏膜屏障功能的完整性.

Objective To study the influence of ω-3 polyunsaturated fatty acids on the serum D-lactate level,diamine oxidase （DAO） activity and urinary lactulose/mannitol （L/M） ratio in patients with severe acute pancreatitis （SAP）.Methods A total of 40 SAP patients were enrolled from August 2012 to May 2014 in departments of general surgery of First Hospital of Shanxi Medical University and People＇s Hospital of Dancheng,Henan.The patients were randomly assigned into research group （n =20） and control group （n =20） using SAS 8.0 statistics software.The control group was given conventional parenteral nutrition （PN） support,while in the research group,fish oil fat emulsion （rich in ω-3 polyunsaturated fatty acids） was used instead of structured triglyceride emulsion.The changes of serum D-lactate level,DAO activity,and urinary L/M ratio were observed on the day of admission,and the 1st,5th,10th day of PN support.Results The serum D-lactate level,DAO activity and urinary L/M ratio of both groups were found decreased after PN.Upon admission and the on the 1 st day of PN,no significant differences were noted between the research group and the control group in the serum D-lactate level [（7.47±0.72） mng/Lvs.（7.31 ±0.54） mg/L,F=0.677,P=0.416; （7.370.68） mg/Lvs.（7.35± 0.59） mg/L,F =0.014,P =0.908],DAO activity [（16.99 ±0.93） U/L vs.（16.83 ±0.82） U/L,F=0.314,P=0.579; （17.12±0.77） U/Lvs.（17.07 ±0.68） U/L,F=0.068,P=0.796] and urinary L/M （0.23 ±0.07 vs.0.22±0.07,F=0.091,P =0.765 ; 0.21± 0.07 vs.0.22±0.08,F=0.119,P=0.732）.On the 5th and 10th day of PN,the research group showed significantly lower compared with the control group：serum D-lactate level [（5.62 ±0.34） mg/L vs.（6.61 ±0.30） mg/L,F=95.242,P=0.000; （2.76±0.55） mg/L vs.（4.56±0.37） mg/L,F=148.052,P=0.000],DAO activity [（7.02 ± 0.93） U/Lvs.（10.40 ±0.68） U/L,F=170.815,P =0.000; （3.32±0.80） U/L vs.（6.09± 0.69） U/L,F=138.645,P=0.000],and urinary L/M （0.57±0.08 vs.0.82±0.07,F=112.668,P=0.000; 0.19±0.12 vs.0.27 ±0.08,F=6.551,P=0.015）.Conclusion Clinical application offish oil emulsion rich in ω-3 polyunsaturated fatty acids in the treatment of SAP can significantly reduce the serum D-lactate level,DAO activity and urinary L/M ratio,suggesting the protective effect of ω-3 polyunsaturated fatty acids on the functional integrity of intestinal mucosal barrier.