Basu R, Muller D P, Papp E, Merryweather I, Eaton S, Klein N, Pierro A
Institute of Child Health and Great Ormond Street Hospital for Children, London, England.
J Pediatr Surg. 1999 Jul;34(7):1091-5. doi: 10.1016/s0022-3468(99)90573-0.
BACKGROUND/PURPOSE: An increase in free radical activity has been observed in patients suffering from a variety of illnesses and has been correlated with disease severity. Free radical production is increased by the administration of total parenteral nutrition (TPN) and may be linked to its adverse effects. Some of the complications of TPN can be ameliorated by partial enteral feeding. The aim of this study was to investigate free radical activity during critical illness and during the administration of parenteral nutrition.
Three groups of surgical infants were studied: (1) control infants (n = 8) before minor surgery, (2) stable infants on the ward recovering from a major operation (n = 24), (3) critically ill infants in the neonatal intensive care unit (NICU, n = 28). Fourteen patients in the ward and 17 patients in NICU were receiving parenteral nutrition. Of the 31 patients on TPN, 9 were also receiving minimal enteral feeding (3% to 24% of total calorie intake). Plasma malondialdehyde (MDA), an index of free radical activity, was measured in all 60 infants. The Paediatric Risk of Mortality (PRISM) score was obtained on NICU patients. The cytokines tumor necrosis factor (TNF-alpha) and interleukin 6 (IL-6) were measured in 25 patients.
Plasma MDA was significantly higher in (1) the stable patients on the ward compared with control patients (P < .001) and (2) patients in NICU compared with stable patients in the ward (P < .001). Parenteral nutrition was associated with higher levels of plasma MDA both in stable patients in the ward and critically ill infants in NICU. There was no correlation between the PRISM score and MDA. In patients not receiving TPN there is a correlation between MDA and TNF-alpha (r = 0.54, P = .02) and between MDA and IL-6 (r = 0.74, P = .001). The level of free radical activity in patients on TPN is not changed by partial enteral feeding.
Critical illness causes a rise in free radical production. Parenteral nutrition causes a significant elevation in free radical activity in both stable infants in the ward and critically ill infants in NICU. The addition of minimal enteral feeding to parenteral nutrition does not reduce free radical activity. We hypothesize that the parenteral nutrition solution directly initiates free radical production.
背景/目的：在患有多种疾病的患者中已观察到自由基活性增加，且与疾病严重程度相关。全胃肠外营养（TPN）会增加自由基生成，这可能与其不良反应有关。部分肠内喂养可改善TPN的一些并发症。本研究旨在调查危重症期间及胃肠外营养给药期间的自由基活性。
对三组外科手术患儿进行了研究：（1）小手术前的对照婴儿（n = 8），（2）病房中从大手术恢复的稳定婴儿（n = 24），（3）新生儿重症监护病房（NICU）中的危重症婴儿（n = 28）。病房中的14名患者和NICU中的17名患者正在接受胃肠外营养。在31名接受TPN的患者中，9名还接受了少量肠内喂养（占总热量摄入的3%至24%）。对所有60名婴儿测量了血浆丙二醛（MDA），这是自由基活性的一个指标。获取了NICU患者的儿科死亡风险（PRISM）评分。对25名患者测量了细胞因子肿瘤坏死因子（TNF-α）和白细胞介素6（IL-6）。
（1）病房中的稳定患者与对照患者相比，血浆MDA显著更高（P <.001）；（2）NICU中的患者与病房中的稳定患者相比，血浆MDA显著更高（P <.001）。胃肠外营养与病房中稳定患者及NICU中危重症婴儿的血浆MDA水平较高有关。PRISM评分与MDA之间无相关性。在未接受TPN的患者中，MDA与TNF-α之间存在相关性（r = 0.54，P =.02），MDA与IL-6之间也存在相关性（r = 0.74，P =.001）。部分肠内喂养不会改变接受TPN患者的自由基活性水平。
危重症会导致自由基生成增加。胃肠外营养会使病房中稳定婴儿及NICU中危重症婴儿的自由基活性显著升高。在胃肠外营养中添加少量肠内喂养不会降低自由基活性。我们推测胃肠外营养溶液直接引发自由基生成。
