Department of Anesthesiology and Critical Care Medicine, Stadtkrankenhaus Frankenthal (Pfalz), Elsa-Brändström-Strasse 1, D-67227 Frankenthal, Germany.
Eur J Anaesthesiol. 2009 Dec;26(12):1076-82. doi: 10.1097/eja.0b013e32832e08e0.
Parenteral nutrition including lipids might be associated with liver disease. The cause leading to parenteral nutrition-related liver dysfunction remains largely unknown but is likely to be multifactorial. The study was performed to assess the effects of a lipid emulsion based on soybean oil, medium-chain triglycerides, olive and fish oil (SMOFlipid20%) compared with a lipid emulsion based on olive and soybean oil on hepatic integrity.
In a prospective, randomized, double-blinded trial, 44 postoperative patients with an indication for parenteral nutrition were allocated to one of two regimens: group A (n = 22) received SMOFlipid, group B (n = 22) a lipid emulsion based on olive and soybean oil for 5 days. Aspartate aminotransferase, alanin-aminotransferase, and serum alpha-glutathion S-transferase were measured before the start of parenteral nutrition (d0), at day 2 (d2), and day 5 (d5) after the start of parenteral nutrition. The significance level was defined at a P value of less than 0.05.
There was no significant difference at d0, but at d2 and d5, significantly lower aspartate aminotransferase (d2: group A: 27 +/- 13 vs. group B: 47 +/- 36 U l(-1); d5: A: 31 +/- 14 vs. B: 56 +/- 45 U l(-1)), alanin-aminotransferase (d2: A: 20 +/- 12 vs. B: 42 +/- 39 U l(-1); d5: A: 26 +/- 15 vs. B: 49 +/- 44 U l(-1)), and alpha-glutathion S-transferase levels (d2: A: 5 +/- 6 vs. B: 17 +/- 21 U l(-1); d5: A: 6 +/- 7 vs. B: 24 +/- 27 microg l(-1)) were found in soybean oil, medium-chain triglycerides, olive and fish oil group compared with the control group.
Hepatic integrity was well retained with the administration of SMOFlipid whereas in patients receiving a lipid emulsion based on olive and soybean oil liver enzymes were elevated indicating a lower liver tolerability.
肠外营养（包括脂肪乳剂）可能与肝病有关。导致肠外营养相关肝功能障碍的原因尚不清楚，但可能是多因素的。本研究旨在评估基于大豆油、中链甘油三酯、橄榄油和鱼油（SMOFlipid20%）的脂肪乳剂与基于橄榄油和大豆油的脂肪乳剂对肝完整性的影响。
在一项前瞻性、随机、双盲试验中，44 名术后需要肠外营养的患者被分配到两个方案组之一：A 组（n=22）接受 SMOFlipid，B 组（n=22）接受基于橄榄油和大豆油的脂肪乳剂，连续 5 天。在开始肠外营养前（d0）、第 2 天（d2）和第 5 天（d5）测量天冬氨酸氨基转移酶、丙氨酸氨基转移酶和血清α-谷胱甘肽 S-转移酶。定义显著性水平为 P 值小于 0.05。
d0 时无显著差异，但在 d2 和 d5 时，天冬氨酸氨基转移酶（d2：A 组：27±13 比 B 组：47±36 U l(-1)；d5：A 组：31±14 比 B 组：56±45 U l(-1)）、丙氨酸氨基转移酶（d2：A 组：20±12 比 B 组：42±39 U l(-1)；d5：A 组：26±15 比 B 组：49±44 U l(-1)）和α-谷胱甘肽 S-转移酶水平（d2：A 组：5±6 比 B 组：17±21 U l(-1)；d5：A 组：6±7 比 B 组：24±27 microg l(-1)）均明显低于对照组。
给予 SMOFlipid 可很好地保留肝完整性，而给予基于橄榄油和大豆油的脂肪乳剂时，肝酶升高，表明肝脏耐受性较低。
