Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients
Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients
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DOI：
10.1007/s00394-005-0573-8
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发表时间：
2006-02-01
影响因子：
5
通讯作者：
Fürst, P
中科院分区：
文献类型：
--
作者：
Grimm, H;Mertes, N;Fürst, P
目的评价一种新型脂肪乳剂降低n-6脂肪酸(FA)含量、增加MUFA和n-3 FA比例及补充维生素E对手术患者脂肪酸和白三烯模式的影响。方法33例腹部大手术患者术后5天内接受等氮、等热量的全胃肠外营养。19名患者服用新的SMOFlide(R)20%，14名患者服用标准豆油乳剂(Lipovenos(R)20%，均为Fresenius Kabi)，每组1.5g脂肪/公斤体重(BW)/d。常规脂质生化、血浆生育酚、血浆磷脂中的脂肪酸模式以及白细胞中白三烯(LT)的释放被评估。此外，还分析了白细胞和血小板磷脂中的脂肪酸类型，但结果未予公布。结果第6天，血浆α-生育酚(34.2+/-10.3mU/L比17.6+/-2.9mU/L)和血浆总n-3脂肪酸(11.1+/-1.9比4.9+/-0.9摩尔%；P&t；0.05)高于对照组(23.8+/-2.2比31.8+/-1.7摩尔%；P<；0.05)；与大豆油乳剂相比，大豆脂肪乳提高了n-3/n-6FA的比值(0.5+/-0.1比0.2+/-0.0p<；0.05)。SMOF使EPA(3.3+/-1.0vs.0.4+/-0.2mol%；p<；0.05)和DHA(6.9+/-1.8vs.3.7+/-0.8mol%；p<；0.05)的比例显著增加，花生四烯酸(AA)的比例不变，而EPA/AA的比例增加(0.7+/-0.2vs.0.1+/-0.0p<；0.05)。第6天LTb5释放增加(8.1+/-5.3vs.1.8+/-3.8pmo1/10(7)PMN，p<；0.05)，LTb4释放减少，但SMOF作用不明显(124.0+/-51.2vs.152.1+/-68.8pmo1/10(7)PMN)。使用SMOF的患者住院天数显著缩短(13.4+/-2.0天vs.20.4+/-10.0天，p<；0.05)。结论新乳剂SMOF的治疗耐受性良好，可调节FA和白三烯模式，具有良好的抗炎作用和进一步的临床疗效。
Objective We assessed the effects of a novel lipid emulsion with reduced content of n-6 fatty acids (FA), increased share of MUFA and n-3 FA and supplemental vitamin E on fatty acid and leukotriene pattern in surgical patients. Methods In a double-blind, randomized study 33 patients received isonitrogenous, isocaloric TPN over 5 postoperative days following major abdominal surgery. 19 patients received the new SMOFlipid(R) 20% and 14 patients a standard soybean oil emulsion (Lipovenoes(R) 20%, both Fresenius Kabi), each 1.5 g fat/kg body weight (BW)/d. Routine lipid biochemistry, plasma tocopherol, fatty acid pattern in plasma phospholipids, as well as leukotriene (LT) release in leukocytes were assessed. Additionally, fatty acid pattern in leukocyte and platelet phospholipids were analysed, but results are not presented. Results On day 6, plasma alpha-tocopherol (34.2 +/- 10.3 vs. 17.6 +/- 2.9 mu mol/L) and, in plasma PL, total n-3 FA were higher (11.1 +/- 1.9 vs. 4.9 +/- 0.9 mol%; p < 0.05) and total n-6 FA lower (23.8 +/- 2.2 vs. 31.8 +/- 1.7 mol%; P < 0.05); the ratio n-3/n-6 FA being elevated (0.5 +/- 0.1 vs. 0.2 +/- 0.0 p < 0.05) with SMOFlipid compared to the soybean oil emulsion. The shares of EPA (3.3 +/- 1.0 vs. 0.4 +/- 0.2 mol%; p < 0.05) and DHA (6.9 +/- 1.8 vs. 3.7 +/- 0.8 mol%; p < 0.05) were highly increased but that of arachidonic acid (AA) was unchanged with SMOFlipid while the ratio EPA/AA was increased (0.7 +/- 0.2 vs. 0.1 +/- 0.0 p < 0.05). LTB5 release was enhanced on day 6 (8.1 +/- 5.3 vs. 1.8 +/- 3.8 pmol/10(7) PMN, p < 0.05) and liberation of LTB4 was lowered, yet not significantly with SMOFlipid (124.0 +/- 51.2 vs. 152.1 +/- 68.8 pmol/10(7) PMN). Length of hospital stay was significantly shorter with SMOFlipid (13.4 +/- 2.0 vs. 20.4 +/- 10.0 days, p < 0.05). Conclusion Treatment with the new emulsion SMOFlipid is well tolerated and modulates FA and leukotriene pattern suggesting favourable anti-inflammatory effects and further clinical benefits.