Georgiannos S N, Renaut A J, Goode A W
Academic Department of Surgery, Royal London Hospital, Whitechapel, UK.
Int Surg. 1997 Jul-Sep;82(3):301-6.
In a prospective controlled clinical study 30 patients with moderate degree of malnutrition, normal liver and kidneys, and a functioning gastrointestinal tract were randomized to receive a free amino acid and small peptide enteral diet (15 patients) or an isonitrogenous isocaloric parenteral support for at least 10 days (total energy: 2900 kcal, nitrogen: 14.5 g, carbohydrates: 380 g, fat: 112 g, N/non protein calories: 1/175). The parenteral and enteral diets had the same protein/lipid/carbohydrate composition. The data indicated that both routes led to positive nitrogen balance. Nitrogen equilibrium was achieved by day 3 in the TPN group and by day 5 in the enteral group. There were no significant changes in serum albumin within either group. Serum level of transferrin reached a significant increase in both groups (p = 0.003). Thyroxine-binding prealbumin rose significantly in both groups as well (p = 0.019 and 0.004 respectively). Statistically significant rises in lymphocyte counts (p = 0.003 and 0.001 respectively), in levels of C3 (p = 0.009 and 0.001 respectively), IgA (p = 0.002), IgG (p = 0.004 and 0.003 respectively) and IgM (p = 0.004) occurred in either treatment group. There was a high incidence of negative skin tests at the start of the study in the enteral group (73.3%) and the TPN group (60%). By the end of the study the incidence of negative results for this test was 40.0% and 26.6% respectively. Despite maintenance of similar glucose levels in both groups, TPN led to significantly (p = 0.000) higher serum insulin levels. The serum insulin increased almost linearly over the study period, and eventually prevented fat mobilization and lipolysis, so that free fatty acid levels had fallen significantly (p = 0.000). A significant elevation of the liver enzymes over the study period occurred in the TPN group, but not in the enterally fed patients. The present findings provide no evidence that semi-elemental diets are in any way inferior to isonitrogenous isocaloric regimes parenterally given for a short period of time.
在一项前瞻性对照临床研究中，30例中度营养不良、肝肾功能正常且胃肠道功能正常的患者被随机分为两组，一组接受游离氨基酸和小肽肠内饮食（15例患者），另一组接受等氮等热量的肠外营养支持至少10天（总能量：2900千卡，氮：14.5克，碳水化合物：380克，脂肪：112克，氮/非蛋白质热量：1/175）。肠外和肠内饮食的蛋白质/脂质/碳水化合物组成相同。数据表明，两种途径均导致正氮平衡。TPN组在第3天达到氮平衡，肠内组在第5天达到氮平衡。两组内血清白蛋白均无显著变化。两组中转铁蛋白血清水平均显著升高（p = 0.003）。两组中甲状腺素结合前白蛋白也均显著升高（分别为p = 0.019和0.004）。两个治疗组的淋巴细胞计数（分别为p = 0.003和0.001）、C3水平（分别为p = 0.009和0.001）、IgA（p = 0.002）、IgG（分别为p = 0.004和0.003）和IgM（p = 0.004）均有统计学意义的升高。在研究开始时，肠内组（73.3%）和TPN组（60%）的皮肤试验阴性发生率较高。到研究结束时，该试验阴性结果的发生率分别为40.0%和26.6%。尽管两组的血糖水平维持相似，但TPN导致血清胰岛素水平显著升高（p = 0.000）。在研究期间，血清胰岛素几乎呈线性增加，最终阻止了脂肪动员和脂肪分解，因此游离脂肪酸水平显著下降（p = 0.000）。在研究期间，TPN组的肝酶显著升高，而肠内喂养的患者则没有。目前的研究结果没有提供证据表明半要素饮食在任何方面不如短期内给予的等氮等热量肠外营养方案。
