S-腺苷-L-蛋氨酸防治全胃肠外营养所致肝内胆汁郁积的实验研究  

Effect of S-adennosylmethione for the protection of TPN-associated cholestasis

作　　者：刘怡晟[1] 蔡威[1] 吴圣楣[1] 钱龙华[1] 

机构地区：[1]上海第二医科大学附属新华医院上海市儿科医学研究所,上海200092

出　　处：《临床儿科杂志》2005年第4期239-242,共4页Journal of Clinical Pediatrics

基　　金：上海市教委青年科学基金项目(编号03BQ34)

摘　　要：目的研究S腺苷L蛋氨酸(SAMe)对全胃肠外营养(TPN)所致胆汁郁积的防治效果及其对肝细胞凋亡的作用。方法新生兔24只,随机分为正常对照组、TPN对照组、SAMe治疗组,治疗组在TPN同时加用SAMe100mg/(kg·d)。结果SAMe治疗组血清胆汁酸、ALT、AKP、总胆红素、总蛋白和白蛋白与正常对照组相比差异无显著性(P>0.05),直接胆红素仍高于正常对照组(P<0.01),但较TPN对照组有明显下降(P<0.01)。正常对照组肝细胞形态正常;TPN对照组可见明显肝内胆汁郁积表现,并可见肝细胞轻度脂肪变性;SAMe治疗组肝细胞形态基本正常。正常对照组肝细胞凋亡数为0.263%±0.041%;TPN对照组肝细胞凋亡数为1.060%±0.217%;SAMe治疗组肝细胞凋亡数为0.467%±0.182%,较TPN对照组明显降低(P<0.01)。结论SAMe可有效防治TPN所致郁胆,其作用机理可能与抑制肝细胞凋亡有关。Objective To investigate the effect of S-adennosylmethione(SAEe)on the prevention of TPN-induced cholestasis and its role in hepatocyte apoptosis.Methods Twenty-four newborn rabbits were randomly divided into three groups consisting of the normal control group with giving breast milk for one week,the TPN group with giving TPN at the dose of200kcal/kg·d for one week,and the SAEe group with giving TPN plus SAEe at the dose of100mg/kg·d intravenously for one week,respectively.Blood and liver samples were obtained one week later.Serum bile acid,ALT,AKP,total bilirubin,direct reaction bilirubin,albumin and globulin levels were determined by automatic biochemical detection,the hepatic pathological change was observed under the light microscope,and hepatocyte apoptosis was analyzed by TUNEL method.Results There were no significant differences in the levels of serum bile acid,ALT,AKP,total bilirubin,total protein and albumin between the SAEe group and the control group(P>0.05).The level of direct reaction bilirubin in SAEe group was obviously higher than that in control group(P<0.01)and significantly lower than that in TPN group(P<0.01).Cholestatic changes and mild hepatic steatosis were observed in TPN group,while no changes of hepatic steatosis and cholestasis were found in SAEe group with normal hepatic morphology.The apoptotic cell counts were0.263±0.041%in normal control group,1.060±0.217%in TPN group,and0.467±0.182%in SAEe group,respectively.The apoptotic cells was much more in TPN group than that in normal group(P<0.01),and much less in SAEe group than that in TPN group(P<0.05),respectively.Conclusions TPN can cause cholestasis and increase hepatocellular apoptosis in newborn rabbits,which may play an important role in cholestatic injury.SAEe can prevent TPN-induced cholestasis effectively,the inhibition of hepatocellular apoptosis may be one of its mechanism.

关 键 词：S-腺苷-L-蛋氨酸 全胃肠外营养 胆汁郁积 

分 类 号：R459.3[医药卫生—治疗学]