不同脂肪组分营养支持影响肝移植病人蛋白质代谢的临床研究  

Clinical research of effects of nutrition support containing differential fatty acids ingredient on improving protein catabolism 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器官移植中心肝胆外Ⅱ科,山东济南250021

出　　处：《中国实用外科杂志》2010年第6期480-483,共4页Chinese Journal of Practical Surgery

基　　金：山东省2007年科学技术发展计划(2007GG3WZ02042);山东省自然科学基金(Y2008C22)

摘　　要：目的比较肝移植病人术后施行肠内、肠外营养对蛋白质代谢的影响,探讨中链脂肪乳(MCT)长链脂肪乳(LCT)改善肝脏移植机体营养状态的作用机制。方法将肝脏移植术后进行营养支持的86例病人随机分为4组(F组、N组、K组、C组),分组检测肝脏移植病人术前1d、术后1、4、7、10d蛋白质代谢情况。结果肝移植后机体蛋白分解增加,血清蛋白水平下降;F、N组病人血清转铁蛋白、前白蛋白水平明显高于K、C组;F、N组尿-3甲基组氨酸排出明显低于K、C组;在施行肠内营养的两组病人中,F组病人血清转铁蛋白、前白蛋白水平明显高于N组,F组病人尿-3甲基组氨酸排出量明显低于N组;术后第3天起与C组相比,F、N、K组病人每日氮平衡和累计氮平衡差异均有统计学意义(P<0.05或P<0.01)。结论含MCT/LCT的肠内营养较只含LCT的营养支持能更有效地减轻肝脏移植病人术后机体蛋白质分解,加快机体从分解代谢向合成代谢的转变,从而改善肝脏移植术后病人的营养状况。Objective To compare the difference of effects between enteral nutrition and parenteral nutrition formula containing either MCT/LCT or LCT only on protein metabolism of liver transplantation（LTP） patients and determine 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 all the cases were divided into 4 groups. The several parameters were observed before liver transplantation lday and after liver transplantation 1, 4, 7 and 10 days, such as serum concentrations of transferrin and prealbumin. Results The results showed that the patients of F, N group had an increased blood concentration of transferrin, prealbumin than those of the patients of K, C group（ 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〈O.05 or P〈 0.01）. Excretion of nitrogen and 3-methylhistidine in urine was also markedly reduced in patients fed with nutrients containing MCT/LCT compared with LCT（P〈0.05 or P〈0.01）. Nitrogen balance was better in group F than that in N and K group. 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 liver transplantation more effectively.

关 键 词：肝脏移植 肠内营养 肠外营养 中链脂肪 

分 类 号：R6[医药卫生—外科学]