The impact of an omega-3 fatty acid rich lipid emulsion on fatty acid profiles in critically ill septic patients
The impact of an omega-3 fatty acid rich lipid emulsion on fatty acid profiles in critically ill septic patients
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DOI：
10.1016/j.plefa.2016.07.001
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发表时间：
2016-09-01
影响因子：
3
通讯作者：
Dennison, Ashley R.
中科院分区：
文献类型：
--
作者：
Hall, Thomas C.;Bilku, Dilraj K.;Dennison, Ashley R.
背景：重症监护室(ITU)的脓毒症死亡之前，常常会出现炎症失控导致的多器官衰竭。用omega-3(n-3)脂肪酸(FA)治疗，主要是二十碳五烯酸(EPA)和二十二碳六烯酸(DHA)，已被证明可以减轻失控炎症的影响，并可能在临床上有益于降低器官功能障碍的死亡率。鱼油(FO)是EPA和DHA的来源之一。方法：采用随机对照的方法，研究静脉(静脉)营养对FO(0.092 g EPA+DHA/kg体重/d)的影响。结果：41例患者(21例服用鱼油；20例对照组)同意采血，分别于0、1、2、3、5、7、10、13天采血；由于死亡、患者出院和撤回同意，可供分析的血样数量随着时间的推移而减少。用气相色谱法测定血浆磷脂酰胆碱(PC)、血浆非酯化脂肪酸(NEFAs)和外周血单个核细胞(PBMCs)的脂肪酸组成。EPA和DHA被迅速整合到所研究的3个脂质库中。血浆PC和NEFAs中花生四烯酸(AA)/EPA+DHA比值降低。FO组死亡率(13.3%，n=4)低于对照组(26.7%，n=8)，但差异无统计学意义。PBMC和血浆PC中AA/(EPA+DHA)比值的降低与存活率显著提高有关。重症脓毒症患者输注FO后，血浆PC、血浆NEFA和PBMC FA谱迅速改变。结论：大剂量n-3FA可导致EPA和DHA迅速显著升高，AA/(EPA+DHA)比值降低。后一种减少与存活率的提高有关。皇冠版权所有(C)2016由爱思唯尔有限公司出版。保留所有权利。
Background: Death from sepsis in the intensive therapy unit (ITU) is frequently preceded by the development of multiple organ failure as a result of uncontrolled inflammation. Treatment with omega-3 (n-3) fatty acids (FAs), principally eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been demonstrated to attenuate the effects of uncontrolled inflammation and may be clinically beneficial in reducing mortality from organ dysfunction. Fish oil (FO) is a source of EPA and DHA.Methods: A randomized trial investigating the effects of parenteral (intravenous) nutrition providing FO (0.092 g EPA+DHA/kg body weight/day) was conducted. Sixty consecutive ITU patients diagnosed with sepsis were randomised to receive either once daily parenteral FO and standard medical care or standard medical care only.Results: Forty one patients (21 received fish oil; 20 controls) consented to blood sampling and blood was taken on days 0, 1, 2, 3, 5, 7, 10 and 13; because of deaths, patient discharge and withdrawal of consent, the number of blood samples available for analysis diminished with time. FA composition of plasma phosphatidylcholine (PC), plasma non-esterified FAs (NEFAs) and peripheral blood mononuclear cells (PBMCs) was determined by gas chromatography. EPA and DHA were rapidly incorporated into all 3 lipid pools investigated. There was a reduction in the arachidonic acid (AA) to EPA+DHA ratio in plasma PC and NEFAs. Fewer patients died in the FO group (13.3% (n=4)) compared with the control group (26.7% (n=8)) but this difference was not significant. A reduction in the AA/(EPA+DHA) ratio in PBMCs and plasma PC was associated with significantly improved survival. Plasma PC, plasma NEFA and PBMC FA profiles are rapidly altered by FO infusion in critically ill septic patients.Conclusion: The provision of high dose n-3 FAs resulted in a rapid and significant increase in EPA and DHA and a reduction in AA/(EPA+DHA) ratio. This latter reduction is associated with improved survival. Crown Copyright (C) 2016 Published by Elsevier Ltd. All rights reserved.