肝移植后炎症因子谱改变及ω-3鱼油脂肪乳的影响

中国组织工程研究与临床康复 第15卷 第31期 2011–07–30出版

Journal of Clinical Rehabilitative Tissue Engineering Research July 30, 2011 Vol.15, No.31

P .O. Box 1200, Shenyang 110004

5726

Liver Transplantation Center of Nanjing Military Command, the 81 Hospital of Chinese PLA,

Nanjing 210002, Jiangsu Province, China

Jiang Tao ★, Master, Attending physician, Liver Transplantation Center of Nanjing Military Command, the 81 Hospital of Chinese PLA,

Nanjing 210002, Jiangsu Province, China

jiangsht@

Supported by: a General Program of Nanjing Military

Command of Chinese PLA, No. 08MA050*

Received: 2011-05-21 Accepted: 2011-06-29

解放军第81医院南京军区肝移植中心，江苏省南京市 210002

江涛★，男，1971年生，安徽省安庆市人，汉族，2002年解放军第二军医大学毕业，硕士，主治医师，主要从事临床肝移植及围手术期管理工作。 jiangsht@

中图分类号:R617 文献标识码:A

文章编号:1673-8225 (2011)31-05726-05

收稿日期：2011-05-21

修回日期：2011-06-29 (20110609002/GW • S)

肝移植后炎症因子谱改变及ω-3鱼油脂肪乳的影响*★

江 涛，王 轩，杨爱珍，陆 雷，张冬华，张荣生

Effects of omega-3 fish oil emulsion on changes in serum cytokines after liver transplantation

Jiang T ao, Wang Xuan, Yang Ai-zhen, Lu Lei, Zhang Dong-hua, Zhang Rong-sheng

Abstract

BACKGROUND: Omega-3 fish oil emulsion can adjust systemic inflammatory response after liver transplantation.

OBJECTIVE: To investigate the effects of omega-3 fish oil emulsion on the changes of cytokines and the prognosis of patients undergoing liver transplantation.

METHODS: All 36 orthotopic liver transplantation patients were prospectively randomized into two groups: experimental and control. After liver transplantation, two group patients received isocaloric and isonitrogenous nutritional support and the same immunosuppressive regimen. From day 2 after liver transplantation, the experimental group patients received omega-3 fish oil emulsion for successive 6 days while the control group patients did not.

RESULTS AND CONCLUSION: Compared with the control group, on days 5, 8 after liver transplantation, interleukin (IL)-1β, IL-2, IL-6, tumor necrosis factor (TNF)-α, prostaglandin E2, and leucotriene B4 were downregulated to different degrees, IL-4, IL-10, TNF-β and leukotriene were upregulated to different degrees in the experimental group. On day 8 after liver transplantation, the ratio of IL-6/IL-10 was significantly decreased and the ratio of IL-10/ TNF-α was significantly increased (P < 0.01). There was no significant difference in perioperative mortality and acute rejection incidence between experimental and control groups. However, The postoperative ICU stay time and hospital stay time were significantly shorter in the experimental group than in the control group (P < 0.05). These results showed that additional omega-3 fish oil emulsion in liver transplantation patients can effectively decline the levels of proinflammatory cytokines and retrieve the extra inflammatory response, modulate the balance of pro-/anti-inflammation, and improve prognosis.

Jiang T, Wang X, Yang AZ, Lu L, Zhang DH, Zhang RS. Effects of omega-3 fish oil emulsion on changes in serum cytokines after liver transplantation. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(31): 5726-5730. [ ]

摘要

背景：ω-3鱼油脂肪乳可改变肝移植后机体的炎症状态。

目的：观察ω-3鱼油脂肪乳对肝移植后炎症因子谱及预后的影响。 方法：将36例同种异体原位肝移植患者前瞻性随机分为实验组和对照组。两组移植后给予等氮等热量的营养支持和相同的免疫抑制方案，实验组移植后第2天在中长链脂肪乳中添加ω-3鱼油脂肪乳，连用6 d ；对照组中长链脂肪乳中未添加。

结果与结论：与对照组比较，实验组移植后第5，8天白细胞介素1β、白细胞介素2、白细胞介素6、肿瘤坏死因子α、前列腺素E2和白三烯B4等不同程度下调；白细胞介素4、白细胞介素10、转化生长因子β和白三烯B5等不同程度上调；移植后第8天白细胞介素6/白细胞介素10显著下降，白细胞介素10/肿瘤坏死因子α升高 (P < 0.01)。两组围手术期死亡率和急性排斥反应发生率差异无显著性意义，但实验组重症监护时间和住院时间显著短于对照组(P < 0.05)。说明肝移植后添加ω-3鱼油脂肪乳可调整促炎/抗炎因子平衡，纠正过度炎症反应，改善预后。 关键词：鱼油；肝移植；炎症；细胞因子；炎症因子 doi:10.3969/j.issn.1673-8225.2011.31.006

江涛，王轩，杨爱珍，陆雷、张冬华、张荣生.肝移植后炎症因子谱改变及ω-3鱼油脂肪乳的影响J].中国组织工程研究与临床康复，2011，15(31):5726-5730. [ ]

0 引言

肝移植患者移植前大部分为终末期肝病，

存在营养不良、感染和多器官功能障碍等病理生理改变，而移植过程中与移植后又受到创伤、大量出血、血流阻断、缺血再灌注损伤、菌群易位、免疫抑制和排斥反应等多种外来因素的影响，造成机体内环境剧烈变动，其中尤以炎症因子谱的改变最为突出。

研究表明，移植后多种细胞因子迅速上调，造成促炎/抗炎细胞因子释放失衡和过度炎症反应，并导致全身炎症反应综合征以至于出现多器官功能障碍综合征，是肝移植围手术

期预后不良的主要原因[1]。

ω-3鱼油脂肪乳可优化脂肪酸的摄入结构，调节脂类炎症因子的合成和细胞因子的释放，进而调控感染、创伤等条件下机体过度的炎症反应，调整免疫状态，起到营养和药理的双重作用[2]。本实验拟在肝移植后患者的营养方案中添加ω-3鱼油脂肪乳，探讨其对于移植后炎症因子谱及预后的影响。