大鼠全胃肠外营养后胆汁淤积的发生机制  

The mechanism of cholestasis following total parenteral nutrition in rats

作　　者：夏强[1] 花天放[1] 张延龄[2] 钟福全[1] 张明珍[1] 刘小弟[3] 

机构地区：[1]上海市第一人民医院普外科,200080 [2]上海医科大学附属华山医院普外科 [3]上海市第一人民医院,200080

出　　处：《中华实验外科杂志》1999年第5期404-405,共2页Chinese Journal of Experimental Surgery

摘　　要：目的　观察脂肪乳剂对大鼠肝胆汁分泌及肝组织结构的影响，探讨全胃肠外营养（ Ｔ Ｐ Ｎ）后胆汁淤积的发生机制。方法　将４０ 只大鼠随机分成４ 组。对照组予以标准颗粒饲料喂养。３ 组实验组行 Ｔ Ｐ Ｎ５ 天后测定胆汁流量及其成分、最大胆酸排泄量（ Ｔｍ） 和非胆酸依赖性胆流（ Ｂ Ａ Ｉ Ｆ） ，观察肝脏组织学变化。结果　３ 组实验组胆流和 Ｂ Ａ Ｉ Ｆ 均下降， Ｔｍ 亦明显下降，并可见不同程度的肝细胞脂肪浸润和轻度胆汁淤积。结论　短期 Ｔ Ｐ Ｎ 致大鼠胆汁淤积发生，其原因与禁食有关，其机制可能与肝细胞受损、 Ｎａ＋ 、 Ｋ＋ Ａ Ｔ Ｐ 酶活性降低有关，与脂肪乳剂使用无关。Objective\ To observe the effect of total parenteral nutrition (TPN) on hepatic transport of bile and histologic feature and to investigate the mechanism of cholestasis following TPN in rats.Methods\ 40 rats were randomly divided into four groups. The control rats were given standard pelleted diet. In three treatment groups of rats, a specially formulated TPN solution was infused for 5 days. After 5 days the common bile duct of rats were cannulated. Bile was quantitatively collected and bile composition was analyzed. Hepatic bile acid transport maximum (Tm) and bile acid independent flow (BAIF) were determined. Histologic changes of livers were studied as well.Results\ Bile flow, ABIF and Tm were markedly reduced in the three experimental groups. Liver microscopic examination showed fatty infiltration of hepatocytes to some extent and a mild cholestasis in the three experimental groups. Conclusion\ Cholestasis happened following TPN with or without fat emulsion in rats. Fast may be an important cause, and hepatocytes injury and reduced Na +, K + ATPase activity may be the mechanism of cholestasis following TPN.\;

关 键 词：脂肪乳剂 胆汁淤积 全胃肠外营养 大鼠 

分 类 号：R459.3[医药卫生—治疗学] R657.430.2[医药卫生—临床医学]