Lekka Marilena E, Liokatis Stamatis, Nathanail Christos, Galani Vasiliki, Nakos George
Chemistry Department, Medical School, University of Ioannina, Greece.
Am J Respir Crit Care Med. 2004 Mar 1;169(5):638-44. doi: 10.1164/rccm.200305-620OC. Epub 2003 Dec 4.
The aim of this study was to evaluate the effect of parenteral nutrition containing medium- and long-chain triglycerides on the function of the respiratory system and to investigate mechanisms involved in this process. We studied 13 patients with acute respiratory distress syndrome (ARDS), 8 receiving lipid and 5 placebo, and 6 without ARDS, receiving lipid. Bronchoalveolar lavage (BAL) was performed before and 1 hour after administration of lipid or placebo. In patients with ARDS, lipid administration resulted in deterioration of oxygenation (Pa(O(2))/FI(O(2)): from 129 +/- 37 to 95 +/- 42), compliance of respiratory system (from 39.2 +/- 12 to 33.1 +/- 9.2 ml/cm H(2)O), and pulmonary vascular resistance (from 258 +/- 47 to 321 +/- 58 dyne x s x cm(-5)). In the BAL fluid of the same group, an increase in total protein and phospholipid concentrations, phospholipase activities, platelet-activating factor and neutrophils, as well as alterations in BAL lipid profile were observed. No significant changes were observed in the control or in the ARDS-Placebo groups. In conclusion, this study indicates that administration of medium- and long-chain triglycerides in patients with ARDS causes alterations in lung function and hemodynamics. Inflammatory cells, possibly activated by lipids, release phospholipase A(2) and platelet-activating factor, enhancing edema formation, inflammation, and surfactant alterations.
本研究旨在评估含中长链甘油三酯的肠外营养对呼吸系统功能的影响，并探究此过程中的相关机制。我们研究了13例急性呼吸窘迫综合征（ARDS）患者，其中8例接受脂质治疗，5例接受安慰剂治疗，以及6例非ARDS患者接受脂质治疗。在给予脂质或安慰剂之前及之后1小时进行支气管肺泡灌洗（BAL）。在ARDS患者中，给予脂质导致氧合恶化（Pa(O₂)/FI(O₂)：从129±37降至95±42）、呼吸系统顺应性（从39.2±12降至33.1±9.2 ml/cm H₂O）以及肺血管阻力（从258±47增至321±58 dyne×s×cm⁻⁵）。在同一组的BAL液中，观察到总蛋白和磷脂浓度、磷脂酶活性、血小板活化因子和中性粒细胞增加，以及BAL脂质谱改变。在对照组或ARDS - 安慰剂组中未观察到显著变化。总之，本研究表明，在ARDS患者中给予中长链甘油三酯会导致肺功能和血流动力学改变。可能被脂质激活的炎症细胞释放磷脂酶A₂和血小板活化因子，增强水肿形成、炎症和表面活性剂改变。
