Cabré E, Navarro E, de Ramon M, Klaassen J, Planas R, Mingorance M D, Pastor M C, Lachica M, Boix J, Gassull M A
Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.
JPEN J Parenter Enteral Nutr. 1996 May-Jun;20(3):198-205. doi: 10.1177/0148607196020003198.
Portacaval anastomosis has an hypolipemic effect in familial hypercholesterolemia and in healthy animals. In cirrhosis, it raises serum cholesterol, but there is no information on its effect upon plasma fatty acids. However, indirect data suggest that portacaval shunting might contribute to the polyunsaturated fatty acid deficit of these patients. We assessed the effect of portacaval anastomosis on plasma fatty acid profile in cirrhosis.
Forty-four Child-Pugh class A/B bleeding cirrhotics were randomized to be treated with portacaval anastomosis (n = 20) or nonsurgical therapy (n = 24). Fatty acid profile in plasma total lipids, alcohol intake, anthropometry, Child-Pugh score, serum cholesterol, triglycerides, and antioxidant micronutrients were assessed before and 3, 6, 12, 18, and 24 months after surgery or the start of nonsurgical therapy. Time course of plasma fatty acids was assessed using unbalanced repeated measures models with the above mentioned variables acting as covariates.
No changes in the time course of percent plasma saturated, monounsaturated, and essential fatty acids were found between groups. Percent long-chain omega-6 and omega-3 polyunsaturated fatty acids decreased during follow-up in shunted patients compared with controls (p = .007 and p < .0005). However, this was not due to a true decrease in polyunsaturated fatty acid levels but to greater increases in saturated and monounsaturated fatty acid concentrations in shunted patients compared with control patients (p = .047 and p = .006).
Portacaval anastomosis does not worsen plasma polyunsaturated fatty acid deficiency in cirrhosis. However, by increasing saturated and monounsaturated fatty acids, it further decreases plasma lipid unsaturation.
门腔静脉吻合术对家族性高胆固醇血症患者及健康动物具有降血脂作用。在肝硬化患者中，该手术会使血清胆固醇升高，但关于其对血浆脂肪酸的影响尚无相关信息。然而，间接数据表明门腔分流术可能是导致这些患者多不饱和脂肪酸缺乏的原因之一。我们评估了门腔静脉吻合术对肝硬化患者血浆脂肪酸谱的影响。
44例Child-Pugh A/B级出血性肝硬化患者被随机分为两组，分别接受门腔静脉吻合术治疗（n = 20）或非手术治疗（n = 24）。在手术前以及术后3、6、12、18和24个月或非手术治疗开始前及相应时间点，评估血浆总脂质中的脂肪酸谱、酒精摄入量、人体测量指标、Child-Pugh评分、血清胆固醇、甘油三酯以及抗氧化微量营养素。使用不平衡重复测量模型评估血浆脂肪酸的时间进程，将上述变量作为协变量。
两组间血浆饱和脂肪酸、单不饱和脂肪酸和必需脂肪酸百分比的时间进程均无变化。与对照组相比，分流患者在随访期间长链ω-6和ω-3多不饱和脂肪酸百分比下降（p = 0.007和p < 0.0005）。然而，这并非由于多不饱和脂肪酸水平的真正下降，而是与对照患者相比，分流患者的饱和脂肪酸和单不饱和脂肪酸浓度升高幅度更大（p = 0.047和p = 0.006）。
门腔静脉吻合术不会加重肝硬化患者血浆多不饱和脂肪酸缺乏。然而，通过增加饱和脂肪酸和单不饱和脂肪酸，它会进一步降低血浆脂质的不饱和度。
