富含ω-3 脂肪酸的脂肪乳剂对急性呼吸窘迫综合征（ARDS）中花生四烯酸合成的影响：一项前瞻性、随机、双盲、平行组研究。
Effects of an omega-3 fatty acid-enriched lipid emulsion on eicosanoid synthesis in acute respiratory distress syndrome (ARDS): A prospective, randomized, double-blind, parallel group study.
机构信息
Nutritional Support Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, 119-129, 08035 Barcelona, Spain.
出版信息
Nutr Metab (Lond). 2011 Apr 8;8(1):22. doi: 10.1186/1743-7075-8-22.
BACKGROUND
The use of lipid emulsions has been associated with changes in lung function and gas exchange which may be mediated by biologically active metabolites derived from arachidonic acid. The type and quantity of the lipid emulsions used could modulate this response, which is mediated by the eicosanoids. This study investigates the use of omega-3 fatty acid-enriched lipid emulsions in ARDS patients and their effects on eicosanoid values.
METHODS
Prospective, randomized, double-blind, parallel group study carried out at the Intensive Medicine Department of Vall d'Hebron University Hospital (Barcelona-Spain). We studied 16 consecutive patients with ARDS and intolerance to enteral nutrition (14 men; age: 58 ± 13 years; APACHE II score 17.8 ± 2.3; Lung Injury Score: 3.1 ± 0.5; baseline PaO2/FiO2 ratio: 149 ± 40). Patients were randomized into two groups: Group A (n = 8) received the study emulsion Lipoplus® 20%, B. Braun Medical (50% MCT, 40% LCT, 10% fish oil (FO)); Group B (n = 8) received the control emulsion Intralipid® Fresenius Kabi (100% LCT). Lipid emulsions were administered for 12 h at a dose of 0.12 g/kg/h. We measured LTB4, TXB2, and 6-keto prostaglandin F1α values at baseline [immediately before the administration of the lipid emulsions (T-0)], at the end of the administration (T-12) and 24 hours after the beginning of the infusion (T 24) in arterial and mixed venous blood samples.
RESULTS
In group A (FO) LTB4, TXB2, 6-keto prostaglandin F1α levels fell during omega-3 administration (T12). After discontinuation (T24), levels of inflammatory markers (both systemic and pulmonary) behaved erratically. In group B (LCT) all systemic and pulmonary mediators increased during lipid administration and returned to baseline levels after discontinuation, but the differences did not reach statistical significance. There was a clear interaction between the treatment in group A (fish oil) and changes in LTB4 over time.
CONCLUSIONS
Infusion of lipids enriched with omega-3 fatty acids produces significant short- term changes in eicosanoid values, which may be accompanied by an immunomodulatory effect.
TRIAL REGISTRATION
ISRCTN63673813.
背景
脂乳剂的使用与肺功能和气体交换的变化有关，这些变化可能是由源自花生四烯酸的生物活性代谢物介导的。脂乳剂的类型和数量可能会调节这种反应，这种反应是由类二十烷酸介导的。本研究调查了富含ω-3 脂肪酸的脂乳剂在 ARDS 患者中的应用及其对类二十烷酸值的影响。
方法
前瞻性、随机、双盲、平行组研究在瓦尔德希伯伦大学医院（西班牙巴塞罗那）的重症医学科进行。我们研究了 16 例 ARDS 患者和不能耐受肠内营养的患者（14 名男性；年龄：58 ± 13 岁；APACHE II 评分 17.8 ± 2.3；肺损伤评分：3.1 ± 0.5；基线 PaO2/FiO2 比值：149 ± 40）。患者随机分为两组：A 组（n = 8）接受研究用乳剂 Lipoplus® 20%，B. Braun Medical（50% MCT，40% LCT，10%鱼油（FO））；B 组（n = 8）接受对照乳剂 Intralipid® Fresenius Kabi（100% LCT）。脂乳剂以 0.12 g/kg/h 的剂量输注 12 小时。我们在基线[在开始输注脂乳剂之前（T-0）]、输注结束时（T-12）和输注开始后 24 小时（T24）测量动脉和混合静脉血样中的 LTB4、TXB2 和 6-酮前列腺素 F1α 值。
结果
在 A 组（FO）中，ω-3 给药期间 LTB4、TXB2、6-酮前列腺素 F1α 水平下降（T12）。停药后（T24），全身和肺内炎症标志物水平表现不稳定。在 B 组（LCT）中，所有全身和肺内介质在脂类给药期间增加，并在停药后恢复至基线水平，但差异无统计学意义。A 组（鱼油）的治疗与 LTB4 随时间的变化之间存在明显的相互作用。
结论
输注富含ω-3 脂肪酸的脂乳剂会导致短时间内类二十烷酸值发生显著变化，这可能伴随着免疫调节作用。
试验注册
ISRCTN63673813。
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