不同脂肪组份营养支持对肝移植受者蛋白质代谢的影响  

Effects of nutrition support containing differential fatty adds ingredient on protein metabolism of liver transplantation patients

作　　者：周旭[1] 刘军[1] 杨凤辉[1] 许世峰[1] 公伟[1] 于光圣[1] 徐延田[1] 卢俊[1] 

机构地区：[1]山东大学附属省立医院,济南250021

出　　处：《中华器官移植杂志》2010年第4期208-212,共5页Chinese Journal of Organ Transplantation

基　　金：山东省2007年科学技术发展计划（2007GG3WZ02042）;山东省优秀中青年科学家科研奖励基金（2007BS03038）

摘　　要：目的 比较肝移植术后给予含中/长链混合脂肪乳剂（MCT/LCT）与只含长链脂肪乳剂（LCT）的肠内和胃肠外营养制剂对受者蛋白质代谢的影响.方法 将86例肝移植受者随机分为4组：MCT/LCT组（22例）.经肠内饲以含MCT/LCT的肠内营养制剂（商品名：瑞高）;LCT组（22例）,经肠内饲以只含LCT的肠内营养制剂（商品名：能全力）;全合一组（22例）,经中心静脉给予全合一静脉营养制剂（商品名：卡文）;对照组（20例）,未给予正规营养支持.前三组受者术后10 d内的日平均热卡、脂肪及蛋白摄入量差异均无统计学意义.分别检测各组受者术前1天、术后第1、4、7和10天蛋白质的代谢情况,观察指标包括血清转铁蛋白、前白蛋白、尿-3甲基组氨酸排m及术后1～7 d氮平衡.结果 肝移植后机体蛋白分解增加,血清蛋白水平下降;MCT/LCT组和LCT组受者血清转铁蛋白和前白蛋白水平明显高于全合一组和对照组（P〈0.05或P〈0.01）.而M（MCT/LCT组又明显高于LCT组（P〈0.05）,全合一组明显高于对照组（P〈0.01）;MCT/LCT组和LCT组受者尿-3甲基组氨酸排出明显低于全合一组和对照组（P〈0.05或P〈0.01）,而MCT/LCT组又明显低于LCT组（P〈0.05）;术后第3天起,与对照组相比,MCT/LCT组、LCT组和全合一组受者每日氮平衡和累计氮平衡的差异均有统计学意义（P〈（1.05或P〈0.01）.结论 肝移植术后给予含MCT/LCT的肠内营养制剂较只含LCT的营养支持能更有效地减轻受者机体蛋白质分解,加快机体从分解代谢向合成代谢的转变,从而改善受者的营养状况.Objective To compare the different effects of enteral nutrition vs parenteral nutrition formula containing either MCT/LCT or LCT only on protein metabolism of liver transplantation （LTP） patients and investigate the mechanism of MCT/LCT improving nutritional status of LTP patients.Methods A random controlled clinical trail containing 86 cases of liver transplantation was conducted and 4 groups were set up： group F （n=22）： enteral feeding on Fresubin 750 MCT containing MCT/LCT as fat source; group N （n=22）：enteral feeding on Nutrison containing only LCT as fat source; group K （n=22）：parenteral nutrition with Kabiven （all in one） by central vein （The intake was isonitrogenic, isocalorie and isolipidic in the above 3 groups） group C （n=20）： without performing formal nutritional support.The several parameters were observed one day before and 1, 4, 7 and 10 days after LTP, including serum concentrations of transferrin and prealbumin.Nitrogen in urine per day and excretion of 3-methylhistidine in urine on the day 1, 7 and 10 after LTP were determined.Nitrogen balance was measured daily.Results Blood concentrations of transferring and prealbumin were significantly increased in groups F and N as compared with those in groups K and C （P〈0.05 or P〈0.01 ）.The above two parameters were markedly higher in group F than in group N as same as group K vs group C （P〈0.05 or P〈0.01 ）.Excretion of nitrogen and 3-methylhistidine in urine was also markedly reduced in group F as comparedwith group N （P〈0.05 or P〈0.01） Nitrogen balance was better in group F than that in groups Nand K.Conclusion An enteral compound diet containing MCT/LCT can reduce decomposition of the body proteins, enhance the level of serum albumin, and improve the status of protein metabolism of patients after LTP more effectively.

关 键 词：肝移植 肠道营养 脂肪类 营养疗法 

分 类 号：R657.3[医药卫生—外科学]