Gelas P, Cotte L, Poitevin-Later F, Pichard C, Leverve X, Barnoud D, Leclercq P, Touraine-Moulin F, Trépo C, Boulétreau P
Intensive Care Unit, Hotel Dieu, Lyon, France.
JPEN J Parenter Enteral Nutr. 1998 Mar-Apr;22(2):67-71. doi: 10.1177/014860719802200267.
Total parenteral nutrition (TPN) may offer significant clinical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients.
We undertook a prospective randomized double-blind multicenter study comparing the effects of two i.v. lipid emulsions used during TPN: long-chain triglycerides (LCT) or balanced emulsion of long-and medium-chain triglycerides (LCT/MCT). Thirty-three AIDS patients requiring TPN for wasting and reduced oral intake were allocated randomly to receive a ternary TPN mixture consisting of 1.5 g/kg/d proteins, 18 kcal/kg/d lipids, and 12 Kcal/kg/d carbohydrates for 6 days. The following tests were performed at days 0 and 7: immunoglobulins, complement fractions, lymphocyte subpopulations count, and lymphocyte proliferation with mitogens.
Patients were all severely malnourished (weight loss: -14.0 +/- 1.3 kg). No clinical or biological differences were observed between the groups at baseline. At day 7, both groups reported a significant increase in weight. Patients in the LCT group exhibited a significant decrease in phytohemagglutinin A response (p = .04) compared with baseline. Patients in the LCT/MCT group exhibited a lower level of IgM (p = .03) and significant increase in C3 fraction (p = .03) compared with baseline. They also showed a tendency to have a higher CD4/CD8 lymphocyte ratio (p = .07), whereas other immunological parameters remained unchanged
Parenteral ternary mixture containing LCT or LCT/MCT are clinically well tolerated in AIDS patients over 6 days. With 2 g/kg/d of lipids, LCT seems to induce significant abnormalities in lymphocyte function. Such abnormalities are not observed with LCT/MCT.
全胃肠外营养（TPN）可能对患有获得性免疫缺陷综合征（AIDS）的营养不良患者具有显著的临床益处。然而，在这些严重免疫抑制的患者中，肠外脂肪的免疫效应尚不清楚。
我们进行了一项前瞻性随机双盲多中心研究，比较了TPN期间使用的两种静脉脂质乳剂的效果：长链甘油三酯（LCT）或长链和中链甘油三酯的平衡乳剂（LCT/MCT）。33例因消瘦和口服摄入量减少而需要TPN的AIDS患者被随机分配接受由1.5 g/kg/d蛋白质、18 kcal/kg/d脂质和12 kcal/kg/d碳水化合物组成的三元TPN混合物，为期6天。在第0天和第7天进行了以下测试：免疫球蛋白、补体成分、淋巴细胞亚群计数以及用丝裂原刺激的淋巴细胞增殖。
患者均严重营养不良（体重减轻：-14.0±1.3 kg）。两组在基线时未观察到临床或生物学差异。在第7天，两组体重均显著增加。与基线相比，LCT组患者的植物血凝素A反应显著降低（p = 0.04）。与基线相比，LCT/MCT组患者的IgM水平较低（p = 0.03），C3成分显著增加（p = 0.03）。他们还表现出CD4/CD8淋巴细胞比率较高的趋势（p = 0.07），而其他免疫参数保持不变。
含LCT或LCT/MCT的肠外三元混合物在AIDS患者中6天内临床耐受性良好。给予2 g/kg/d的脂质时，LCT似乎会导致淋巴细胞功能出现显著异常。LCT/MCT未观察到此类异常。
