Mayser Peter, Mayer Konstantin, Mahloudjian Mojgan, Benzing Steffen, Krämer Hans-Joachim, Schill Wolf-Bernhard, Seeger Werner, Grimminger Friedrich
Department of Dermatology, Center for Dermatology and Andrology, Justus-Liebig-University, Giessen, Germany.
JPEN J Parenter Enteral Nutr. 2002 May-Jun;26(3):151-8. doi: 10.1177/0148607102026003151.
In the involved epidermis of patients with atopic dermatitis, changes in the metabolism of eicosanoids with increased quantities of the arachidonic acid (AA)-derived lipoxygenase products have been observed. Free eicosapentaenoic acid (EPA), a fish oil-derived alternative (n-3) fatty acid, may compete with AA, resulting in an anti-inflammatory effect.
In a 10-day double-blind, randomized, placebo-controlled trial, 22 patients hospitalized for moderate-to-severe atopic dermatitis were randomly assigned to receive daily infusions of either a n-3 fatty acid-based lipid emulsion (fish oil, 10%; 200 mL/d) or a conventional n-6-lipid emulsion (soybean oil, 10%; 200 mL/d). Topical treatment was restricted to emollients. The severity of disease was evaluated daily with scoring of erythema, infiltration, and desquamation and by subjective patient scoring of clinical manifestations. In addition, plasma-free and total-bound fatty acids and the composition of membrane fatty acids in blood cells (thrombocytes, granulocytes, and erythrocytes), lipid mediators from isolated neutrophils and platelets, and lymphocyte-activation parameters were determined.
Twenty patients completed the trial. Marked improvement from baseline was seen in both groups. On days 6, 7, 8, and 10, disease severity score-defined as the sum of all scores-was more pronounced (p < .05) in the n-3 group compared with the n-6 group. Free arachidonic acid in plasma did not change substantially in both groups, whereas plasma-free EPA, total-bound EPA, and the membrane EPA/AA ratio markedly increased in response to n-3-lipid infusion. In parallel, EPA-derived lipid mediators appeared, whereas lymphocyte functions were unaffected. In the post-treatment period (2/4 weeks), relapse was observed in some patients after n-3 psoralene-ultraviolet A (PUVA) infusion, whereas there was a marked long-term improvement in the n-6 group.
IV n-3-fatty acid administration is effective in acutely improving the severity of atopic dermatitis, paralleled by changes in plasma and membrane fatty acid composition and lipid mediator synthesis. The long-term beneficial effects of IV n-6 fatty acids should be evaluated further.
在特应性皮炎患者受累的表皮中，已观察到类花生酸代谢发生变化，花生四烯酸（AA）衍生的脂氧合酶产物数量增加。游离二十碳五烯酸（EPA）是一种源自鱼油的替代性（n-3）脂肪酸，可能与AA竞争，从而产生抗炎作用。
在一项为期10天的双盲、随机、安慰剂对照试验中，22名因中度至重度特应性皮炎住院的患者被随机分配，每天输注基于n-3脂肪酸的脂质乳剂（鱼油，10%；200 mL/天）或传统的n-6脂质乳剂（大豆油，10%；200 mL/天）。局部治疗仅限于使用润肤剂。每天通过对红斑、浸润和脱屑进行评分以及患者对临床表现的主观评分来评估疾病的严重程度。此外，还测定了血浆游离脂肪酸和总结合脂肪酸、血细胞（血小板、粒细胞和红细胞）中膜脂肪酸的组成、分离的中性粒细胞和血小板中的脂质介质以及淋巴细胞激活参数。
20名患者完成了试验。两组患者与基线相比均有明显改善。在第6、7、8和10天，n-3组的疾病严重程度评分（定义为所有评分的总和）比n-6组更显著（p <.05）。两组患者血浆中的游离花生四烯酸均无显著变化，而输注n-3脂质后，血浆游离EPA、总结合EPA以及膜EPA/AA比值显著增加。同时，出现了源自EPA的脂质介质，而淋巴细胞功能未受影响。在治疗后阶段（2/4周），一些患者在输注n-3补骨脂素-紫外线A（PUVA）后出现复发，而n-6组则有明显的长期改善。
静脉输注n-3脂肪酸可有效急性改善特应性皮炎的严重程度，同时血浆和膜脂肪酸组成以及脂质介质合成也会发生变化。静脉输注n-6脂肪酸的长期有益效果应进一步评估。
