n-3鱼油脂肪乳剂对全胃切除术后患者脂肪酸代谢和炎性介质的影响

Influence of n-3 fish oil fatty emulsion on fatty acid profile and inflammatory mediator in patients underwent total gastrectomy

目的:探讨n-3鱼油脂肪乳剂对全胃切除术后患者脂肪酸代谢、免疫调节和抗炎作用的影响。方法:选择60例全胃切除术后需要肠外营养支持至少5 d以上的患者,按前瞻、随机、盲法、对照原则分为鱼油组(卡文+尤文,30例)和对照组(单纯卡文,30例)。术后第2~8天两组患者按等氮、等热量进行肠外营养支持。于手术前1 d及术后第1、4、8天检测游离脂肪酸谱、炎症反应指标(包括CRP、IL-1、IL-6、TNF-α),流式细胞仪检测细胞免疫指标HLA-DR表达率、T细胞亚群水平,观察APACHE II评分、术后感染率、术后多器官功能障碍综合征(MODS)发生率、住院总时间、住院期间病死率。结果:两组年龄、性别、BMI、TPN治疗前血清炎性因子水平、HLA-DR表达率、T细胞亚群水平、APACHEⅡ评分等差异均无统计学意义(P>0.05),两组具有可比性。TPN治疗后,与对照组比较,鱼油组患者血清n-6/n-3 PUFAs比率下降,AA含量减少,EPA、DHA含量增加,CRP、IL-1、IL-6和TNF-α等炎性因子水平下降更为显著(P<0.05)。鱼油组血清HLA-DR表达率较对照组有所上升(P<0.05),但对CD4+T/CD8+T等T细胞亚群水平无显著影响(P>0.05)。鱼油组住院感染率、MODS发生率、APACHEⅡ评分低于对照组(P<0.05),但两组患者住院总时间、住院期间病死率比较差异统计学意义(P>0.05)。结论:n-3鱼油脂肪乳剂可下调n-6/n-3 PUFAs比率,减少血清中AA含量,增加EPA、DHA含量;可以降低全胃切除患者术后血清IL-1、IL-6、TNF-α炎性因子和CRP水平,有效减轻炎症反应;能提升HLA-DR表达率,减轻免疫抑制;能降低术后感染率、MODS发生率,改善患者急性生理状态。

Objective： To investigate the effects of n-3 fish oil fatty emulsion on fatty acid profile and lipid mediator, immune regulation mechanism and anti-inflammatory effect of inpatients underwent total gastrectomy. Methods： In a prospective,double-blind, and randomized controlled trial,60 patients underwent total gastrectomy were divided into two groups, therapy group and control group. The control group was given routine therapy while the therapy group was given routine therapy and fish oil. The day before the operation,1,4 and 8 days after the operation, The lipid metabolic indices, including free fatty acids spectrum were detected;The inflammation indicator, including c-reactive protein（CRP） and interleukin（IL-1,IL-6）, tumor necrosis factor alpha（TNF-α） were tested; The cellular immune function,including HLA-DR expression rate, the level of T cell subgroup were detected with flow cytometry. The clinical outcome indicators including APACHE II score,postoperative infection and MODS incidence,postoperative hospitalization days,hospitalization mortality were observed. Results： There was no significant difference between Fish oil group and control group in age, sex and BMI, the serum levels of inflammatory cytokines, the HLA-DR expression rate, level of T cell subgroup,APACHE II score, etc.（P〉0.05）, so the two groups are comparable.Compared with control group, the n-6/n-3 PUFAs ratio drops, AA content decreased, but the content of EPA and DHA is increased, in fish oil group, decreased in fish oil group（P〈0.05）; Compared with control group, serum concentration of CRP,IL-6 and TNF-α in patients of therapy group were significantly reduced, and clinical outcome improved. There was no difference in the expression of T cell subgroup between two groups. Conclusion： Application of n-3 fish oil fat emulsion, can lower the n-6/n-3 PUFAs ratio, reduce the AA content in serum, but the content of EPA and DHA is increased;N-3 fish oil fat emulsion can reduce serum after total gastrectomy,IL-1,IL-6,TNF-α inflammatory factor and the concentration of CRP, effectively reduce the inflammatory response in patients with;N-3 fish oil fat emulsion can improve the HLA-DR expression rate, reduce the immunosuppression,but had no significant effect on T cell subgroup level;N-3 fish oil fat emulsion to reduce the incidence of postoperative infection and MODS, improve patients with acute physiology, but had no significant effect on total days in hospital, mortality.