Chambrier Cécile, Bannier Edith, Lauverjat Madeleine, Drai Jocelyne, Bryssine Sylvie, Boulétreau Paul
Centre Agréé de Nutrition Parentérale à Domicile, Hôpital E. HERRIOT, 69437 Lyon, France.
JPEN J Parenter Enteral Nutr. 2004 Jan-Feb;28(1):7-12. doi: 10.1177/014860710402800107.
In long-term parenteral nutrition (LTPN) patients, the use of a 50:50 mixture of medium- and long-chain triglyceride emulsion (MCT/LCT) has been suggested to prevent or correct fatty liver infiltration. However, the use of MCT/LCT lipid emulsion results in a 50% reduction of essential fatty acids and vitamin K1 supply and could induce essential fatty acid and vitamin K1 deficiencies. This study evaluated the effect of a long-term infusion of MCT/LCT lipid emulsion on plasma fatty acid (FA) and vitamin K1 levels on LTPN patients.
In a prospective nonrandomized crossover study, we measured plasma phospholipid FA composition by gas chromatography and vitamin K1 levels by high-performance liquid chromatography in 11 LTPN patients before and after a 4-month replacement of the usual 20% LCT lipid emulsion (20% Lipoven; Fresenius-Kabi France, Sèvres, France) by a 20% MCT/LCT lipid emulsion (Medialipide B; Braun Medical, Boulogne, France).
Patient received LTPN for 46 +/- 40 months; IV lipid emulsion was 827 +/- 336 mL/week. MCT/LCT lipid substitution did not change most of the essential plasma fatty acid concentrations and did not induce essential fatty acid deficiency. With both lipid emulsions, the triene/tetraene (20:3n-9/20:4n-6) ratio remained within the normal ranges. However, with MCT/LCT lipid emulsion, 22:4n-6 (LCT: 0.50 +/- 0.12; MCT/LCT: 0.63 +/- 0.11%) and 22:5n-6 (LCT: 0.32 +/- 0.11; MCT/LCT: 0.48 +/- 0.15%) increased significantly (p = .022 and 0.011, respectively). Plasma vitamin K1 levels decreased drastically with MCT/LCT lipid emulsion.
An amount of 2.85 +/- 1.55 g x kg(-1) week(-1) of MCT/LCT lipid emulsion neither induced essential fatty acid deficiency nor improved the fatty acid disturbances usually observed in LTPN patients but did induce a drop in plasma vitamin K1 levels.
对于长期肠外营养（LTPN）患者，有人建议使用中链和长链甘油三酯乳剂（MCT/LCT）按50:50混合的制剂来预防或纠正脂肪肝浸润。然而，使用MCT/LCT脂质乳剂会使必需脂肪酸和维生素K1的供应量减少50%，并可能导致必需脂肪酸和维生素K1缺乏。本研究评估了长期输注MCT/LCT脂质乳剂对LTPN患者血浆脂肪酸（FA）和维生素K1水平的影响。
在一项前瞻性非随机交叉研究中，我们在11例LTPN患者中将常用的20%长链甘油三酯脂质乳剂（20% Lipoven；法国费森尤斯卡比公司，法国瑟夫尔）替换为20% MCT/LCT脂质乳剂（Medialipide B；法国布劳恩医疗公司，布洛涅）前后，通过气相色谱法测量血浆磷脂脂肪酸组成，通过高效液相色谱法测量维生素K1水平。
患者接受LTPN治疗46±40个月；静脉脂质乳剂用量为827±336毫升/周。MCT/LCT脂质替换并未改变大多数必需血浆脂肪酸浓度，也未引发必需脂肪酸缺乏。使用两种脂质乳剂时，三烯/四烯（20:3n-9/20:4n-6）比值均保持在正常范围内。然而，使用MCT/LCT脂质乳剂时，22:4n-6（长链甘油三酯：0.50±0.12；MCT/LCT：0.63±0.11%）和22:5n-6（长链甘油三酯：0.32±0.11；MCT/LCT：0.48±0.15%）显著增加（p分别为0.022和0.011）。使用MCT/LCT脂质乳剂时，血浆维生素K1水平急剧下降。
每周2.85±1.55克/千克（-1）的MCT/LCT脂质乳剂用量既未引发必需脂肪酸缺乏，也未改善LTPN患者通常出现的脂肪酸紊乱，但确实导致血浆维生素K1水平下降。
Zotero 插件