Heller Axel R, Rössel Thomas, Gottschlich Birgit, Tiebel Oliver, Menschikowski Mario, Litz Rainer J, Zimmermann Thomas, Koch Thea
Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, University of Technology, Dresden, Germany.
Int J Cancer. 2004 Sep 10;111(4):611-6. doi: 10.1002/ijc.20291.
Epidemiologic studies have indicated that high intake of saturated fat and/or animal fat increases the risk of colon and breast cancer. Omega-3 PUFAs in fish oil (FO) can inhibit the growth of human cancer cells in vitro and in vivo. These effects are related to the uptake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into the cellular substrate pool and their competitive metabolism with arachidonic acid (AA) at the cyclooxygenase and 5-lipoxygenase levels. The metabolites of EPA and DHA have less inflammatory and immunosuppressant potency than the substances derived from AA. Based on previous experimental data, we hypothesized that FO supplementation after major abdominal cancer surgery would improve hepatic and pancreatic function. Ours was a prospective, randomized, double-blinded clinical trial on 44 patients undergoing elective major abdominal surgery, randomly assigned to receive total parenteral nutrition (TPN) supplemented with either soybean oil (SO 1.0 g/kg body weight daily, n = 20) for 5 days or a combination of FO and SO (FO 0.2 + SO 0.8 g/kg body weight daily, n = 24). Compared to pure SO supplementation in the postoperative period, FO significantly reduced ASAT [0.8 +/- 0.1 vs. 0.5 +/- 0.1 mmol/(l. sec)], ALAT [0.9 +/- 0.1 vs. 0.6 +/- 0.1 mmol/(l. sec)], bilirubin (16.1 +/- 5.3 vs. 6.9 +/- 0.6 mmol/l), LDH (7.7 +/- 0.4 vs. 6.7 +/- 0.4 mmol/(l. sec) and lipase (0.6 +/- 0.1 vs. 0.4 +/- 0.1 micromol/(l. sec) in the postoperative course. Moreover, patients with increased risk of sepsis (IL-6/IL-10 ratio >8) showed a tendency to shorter ICU stay (18 hr) under omega-3 PUFA treatment. Weight loss as encountered after the SO emulsion of 1.1 +/- 2.2 kg was absent in the FO group. After major abdominal tumor surgery, FO supplementation improved liver and pancreas function, which might have contributed to the faster recovery of patients.
流行病学研究表明，高摄入饱和脂肪和/或动物脂肪会增加患结肠癌和乳腺癌的风险。鱼油（FO）中的ω-3多不饱和脂肪酸（PUFA）在体外和体内均可抑制人类癌细胞的生长。这些作用与二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）摄取到细胞底物池中以及它们在环氧化酶和5-脂氧合酶水平上与花生四烯酸（AA）的竞争性代谢有关。EPA和DHA的代谢产物的炎症和免疫抑制效力低于源自AA的物质。基于先前的实验数据，我们假设在腹部大手术后补充FO会改善肝脏和胰腺功能。我们进行了一项前瞻性、随机、双盲临床试验，对44例行择期腹部大手术的患者进行研究，随机分配接受全胃肠外营养（TPN），其中一组每天补充大豆油（SO 1.0 g/kg体重，n = 20），共5天；另一组补充FO和SO的组合（FO 0.2 + SO 0.8 g/kg体重/天，n = 24）。与术后单纯补充SO相比，FO显著降低了术后谷草转氨酶[0.8 +/- 0.1 vs. 0.5 +/- 0.1 mmol/(l·sec)]、谷丙转氨酶[0.9 +/- 0.1 vs. 0.6 +/- 0.1 mmol/(l·sec)]、胆红素（16.1 +/- 5.3 vs. 6.9 +/- 0.6 mmol/l）、乳酸脱氢酶（7.7 +/- 0.4 vs. 6.7 +/- 0.4 mmol/(l·sec)）和脂肪酶（0.6 +/- 0.1 vs. 0.4 +/- 0.1 micromol/(l·sec)）水平。此外，脓毒症风险增加（IL-6/IL-10比值>8）的患者在接受ω-3 PUFA治疗时，入住重症监护病房（ICU）的时间有缩短趋势（18小时）。FO组没有出现SO乳剂组出现的1.1 +/- 2.2 kg的体重减轻情况。腹部大肿瘤手术后，补充FO改善了肝脏和胰腺功能，这可能有助于患者更快康复。
