Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
Department of Clinical Pharmacy, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
Clin Nutr. 2021 Jun;40(6):3950-3958. doi: 10.1016/j.clnu.2021.04.006. Epub 2021 Apr 20.
BACKGROUND & AIMS: Parenteral nutrition (PN) can supply all essential nutrients to a patient with gastrointestinal insufficiency. However, the sensitivity to lipid peroxidation might increase in those receiving PN, especially home parenteral nutrition (HPN). This study aimed to investigate whether PN affects the antioxidant balance of plasma of HPN patients without comorbidities and whether this balance is influenced by comorbidities and according to the type of lipid emulsion included in the PN.
Adult patients on HPN (n = 86) received one of three types of lipid emulsion (based on 1) soyabean oil, 2) olive and soyabean oil or 3) soyabean, coconut, olive and fish oil) in all-in-one mixtures; in addition healthy controls (n = 66) were studied as comparators. HPN patients were classified to the following subgroups: 1) patients without (n = 58) or with (n = 28) comorbidities 2) patients on Intralipid (G, n = 53), ClinOleic (G, n = 17) or SMOFlipid (Gn = 16). The activities of total glutathione peroxidase (GSH-Px), selenium dependent glutathione peroxidase (Se-GSHPx) and glutathione S-transferase (GST) in plasma were determined spectrophotometrically. The antioxidant potential of plasma was determined using oxygen radical absorbance capacity (ORAC). The lipid peroxidation marker malondialdehyde (MDA) was analyzed with high performance liquid chromatography.
MDA concentration was the highest in G and the lowest in G (p < 0.05). G also had the highest activity of GSH-Px. No differences in Se-GSHPx, GST and ORAC were observed among G, G and G. Comparing with healthy controls, significantly lower GST (p = 0.0293) and ORAC (p < 0.0001) were observed in the HPN patients. Among all measured parameters only the concentration of MDA was significantly higher in patients with comorbidities compared to those without them. Comorbidities did not influence MDA level in G and G being still the lowest in G (p = 0.0033). In contrast, significantly higher MDA level was observed for G in those with vs. without comorbidities (p = 0.0262).
Patients on HPN have lower antioxidant defenses than healthy controls. The type of lipid emulsion used in HPN affects lipid peroxidation (even after taking into account comorbidities which often involve oxidative stress) being the highest in G and the lowest in G. Thus, to minimize the risk of oxidative stress, SMOFlipid can be considered in patients in HPN especially for those with comorbidities. ClinOleic can be considered in HPN patients without comorbidities. The observation should be confirmed in larger studies.
肠外营养（PN）可向胃肠道功能不全的患者提供所有必需营养素。然而，接受 PN 治疗的患者的脂质过氧化敏感性可能会增加，尤其是在家进行肠外营养（HPN）的患者。本研究旨在探讨 HPN 是否会影响无合并症的 HPN 患者血浆中的抗氧化平衡，以及这种平衡是否会受到合并症的影响，并根据 PN 中包含的脂质乳剂的类型而有所不同。
接受 HPN（n=86）的成年患者接受了三种类型的脂质乳剂（基于 1）大豆油、2）橄榄油和大豆油或 3）大豆、椰子、橄榄油和鱼油）的混合乳剂；此外，还将 66 名健康对照者（n=66）作为比较者进行了研究。将 HPN 患者分为以下亚组：1）无合并症（n=58）或有合并症（n=28）的患者 2）使用 Intralipid（G 组，n=53）、ClinOleic（G 组，n=17）或 SMOFlipid（Gn 组，n=16）的患者。使用分光光度法测定血浆中总谷胱甘肽过氧化物酶（GSH-Px）、硒依赖性谷胱甘肽过氧化物酶（Se-GSHPx）和谷胱甘肽 S-转移酶（GST）的活性。使用氧自由基吸收能力（ORAC）测定血浆的抗氧化潜力。使用高效液相色谱法分析脂质过氧化标志物丙二醛（MDA）的浓度。
G 组的 MDA 浓度最高，G 组的 MDA 浓度最低（p<0.05）。G 组的 GSH-Px 活性也最高。G、G 和 G 之间的 Se-GSHPx、GST 和 ORAC 无差异。与健康对照组相比，HPN 患者的 GST（p=0.0293）和 ORAC（p<0.0001）明显较低。在所有测量的参数中，仅 MDA 浓度在合并症患者中明显高于无合并症患者。合并症并不影响 G 和 G 中的 MDA 水平，G 中的 MDA 水平仍然最低（p=0.0033）。相比之下，在有合并症的患者中，G 中的 MDA 水平明显更高（p=0.0262）。
接受 HPN 的患者的抗氧化防御能力低于健康对照组。HPN 中使用的脂质乳剂类型会影响脂质过氧化（即使考虑到常涉及氧化应激的合并症），其中 G 中的脂质过氧化最高，G 中的脂质过氧化最低。因此，为了最大程度地降低氧化应激的风险，可以考虑在家进行 HPN 的患者使用 SMOFlipid，特别是有合并症的患者。对于无合并症的 HPN 患者，可以考虑使用 ClinOleic。这一观察结果需要在更大规模的研究中得到证实。
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