Cabré E, Periago J L, González J, González-Huix F, Abad-Lacruz A, Gil A, Sánchez-Medina F, Esteve-Comas M, Fernández-Bañares F, Planas R
Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
JPEN J Parenter Enteral Nutr. 1992 Jul-Aug;16(4):359-63. doi: 10.1177/0148607192016004359.
Fatty acid levels (from C14:0 to C22:6n3) in plasma lipid fractions were prospectively studied in 11 cirrhotic patients with chronic hepatic encephalopathy and compared with those in 23 cirrhotic patients without chronic hepatic encephalopathy with similar age, sex distribution, and liver and nutritional status, and in 11 age- and sex-matched, healthy subjects. Plasma lipid fractions were separated by thin-layer chromatography and fatty acids were identified by capillary column gas-liquid chromatography. Total n6 polyunsaturated fatty acid plasma levels were lower in cirrhotic patients--with and without chronic hepatic encephalopathy--than in control subjects. In addition, arachidonic acid levels, both in total lipids and fractions, were lower in patients with than in those without chronic encephalopathy. On the other hand, a selective decrease of plasma docosahexaenoic acid (a major component of neuronal membranes) was observed in those patients with chronic encephalopathy as compared with both control and cirrhotic subjects without chronic encephalopathy. These findings may be due to various mechanisms. Differences in long-chain polyunsaturated fatty acid content in fish- and meat-restricted diets partly may account for these findings. However, it could be speculated that polyunsaturated fatty acid biosynthesis may be reduced further in patients with chronic hepatic encephalopathy because of either a decrease in portal essential fatty acid extraction in the postabsorptive phase due to portal-systemic shunting or to the effect of protein-restricted diets. Furthermore, the finding of low plasma docosahexaenoic acid in these patients raises the possibility that this deficiency might be an additional pathogenic factor in chronic hepatic encephalopathy.
对11例患有慢性肝性脑病的肝硬化患者的血浆脂质组分中的脂肪酸水平（从C14:0至C22:6n3）进行了前瞻性研究，并与23例年龄、性别分布、肝脏和营养状况相似但无慢性肝性脑病的肝硬化患者以及11例年龄和性别匹配的健康受试者的脂肪酸水平进行了比较。通过薄层色谱法分离血浆脂质组分，并用毛细管柱气液色谱法鉴定脂肪酸。肝硬化患者（无论有无慢性肝性脑病）的血浆总n6多不饱和脂肪酸水平均低于对照组。此外，患有慢性肝性脑病的患者的总脂质及其组分中的花生四烯酸水平均低于未患慢性肝性脑病的患者。另一方面，与对照组和无慢性肝性脑病的肝硬化患者相比，观察到慢性肝性脑病患者的血浆二十二碳六烯酸（神经细胞膜的主要成分）选择性降低。这些发现可能是由多种机制导致的。鱼类和肉类限制饮食中长链多不饱和脂肪酸含量的差异可能部分解释了这些发现。然而，可以推测，由于门体分流导致吸收后期门静脉必需脂肪酸摄取减少或蛋白质限制饮食的影响，慢性肝性脑病患者的多不饱和脂肪酸生物合成可能会进一步降低。此外，这些患者血浆二十二碳六烯酸水平较低的发现增加了这种缺乏可能是慢性肝性脑病的另一个致病因素的可能性。
