Effect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients
Effect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients
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DOI：
10.1111/aas.12313
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发表时间：
2014-07-01
影响因子：
2.1
通讯作者：
Steiner, L. A.
中科院分区：
文献类型：
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作者：
Burkhart, C. S.;Dell-Kuster, S.;Steiner, L. A.
背景：关于n-3脂肪酸在脓毒症中的免疫调节作用的数据是相互矛盾的。在这项研究中，研究了肠外注射n-3脂肪酸对脓毒症患者脑损伤标志物、脓毒症相关性谵妄发生率和炎症介质的影响。方法将50例脓毒症患者随机分为两组，一组在重症监护室入院后7天内接受含高度精制鱼油（相当于n-3脂肪酸0.12mg/kg/天）的脂质乳剂2ml/kg/天，另一组接受标准治疗。在第1、2、3、7天测量脑损伤标志物和炎症介质。每日评估脓毒症相关谵妄。主要结局是干预组和对照组之间S-100从基线到峰值水平的差异，采用t检验比较。通过拟合广义估计方程模型，探讨了两组中所有标记物随时间的变化。结果干预组与对照组S-100从基线到峰值的平均变化差值分别为0.34 (95% CI: -0.18-0.85) （P=0.19）。我们发现血浆S-100、神经元特异性烯醇化酶、白细胞介素(IL)-6、IL-8、IL-10和c反应蛋白的水平在不同时间组之间没有差异。干预组脓毒症相关谵妄的发生率为75%，对照组为71%（风险差异为4%，95% CI -24-31%， P=0.796）。结论n-3脂肪酸对脓毒症患者脑损伤指标、脓毒症相关性谵妄发生率及炎症介质无影响。
Background Data regarding immunomodulatory effects of parenteral n-3 fatty acids in sepsis are conflicting. In this study, the effect of administration of parenteral n-3 fatty acids on markers of brain injury, incidence of sepsis-associated delirium, and inflammatory mediators in septic patients was investigated. Methods Fifty patients with sepsis were randomized to receive either 2ml/kg/day of a lipid emulsion containing highly refined fish oil (equivalent to n-3 fatty acids 0.12mg/kg/day) during 7 days after admission to the intensive care unit or standard treatment. Markers of brain injury and inflammatory mediators were measured on days 1, 2, 3 and 7. Assessment for sepsis-associated delirium was performed daily. The primary outcome was the difference in S-100 from baseline to peak level between both the intervention and the control group, compared by t-test. Changes of all markers over time were explored in both groups, fitting a generalized estimating equations model. Results Mean difference in change of S-100 from baseline to peak level was 0.34 (95% CI: -0.18-0.85) between the intervention and control group, respectively (P=0.19). We found no difference in plasma levels of S-100, neuron-specific enolase, interleukin (IL)-6, IL-8, IL-10, and C-reactive protein between groups over time. Incidence of sepsis-associated delirium was 75% in the intervention and 71% in the control groups (risk difference 4%, 95% CI -24-31%, P=0.796). Conclusion Administration of n-3 fatty acids did not affect markers of brain injury, incidence of sepsis-associated delirium, and inflammatory mediators in septic patients.