秦荣 晏才杰 第三军医大学新桥医院普外科(重庆.400037) 中国胃肠外科杂志 1999 0 2 1


    关键词：胃癌；间隙连接；Connexin32(Cx32) 期刊 zgwcwkzz 0 论著 fur -->


    

摘要 目的 探讨合理全胃肠外营养(TPN)对硬化肝的影响，以便预防和治疗TPN相关的并发症。方法 Wistar大鼠分为3组：正常组8只，肝硬化对照组6只，肝硬化TPN组7只。观察大鼠生存情况，各组大鼠实验前后体重、肝重/体重比值的变化，TPN组大鼠氮平衡情况，肝功能、肝甘油三酯(TG)、胆固醇(CHO)含量、门静脉血胰岛素、C肽、胰高血糖素浓度的变化以及肝脏病理组织学改变的情况。结果 除TPN组一只大鼠因输液过快，肺水肿死亡外，其余大鼠均成活，实验前后体重无明显变化。与对照组比较，TPN组血清TBIL、AST和ALT无显著性差异(P>0.05)，ALB、A/G比值明显降低(P<0.05)，肝TG、CHO含量明显升高(P<0.05)，门静脉血胰岛素、C肽浓度升高不明显，而胰高血糖素浓度明显升高(P<0.05)。肝脂肪变性程度，正常组为0级，对照组Ⅰ级，TPN组Ⅳ级。电镜观察，肝细胞质内对照组有少量的脂肪滴，而TPN组有多量的脂肪滴，两组肝细胞质内线粒体均轻度肿胀。结论 合理的TPN对硬化肝仍有损害，且TPN也未能增加血清白蛋白浓度，因此硬化肝TPN时必须预防和治疗进一步的肝损害，且必须用白蛋白强化。

Effects of total parenteral nutrition on liver in the cirrhotic rats

Luo Shimin, Liang Lijian.

    Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yan-Sen University of Medical Sciences, Guangzhou 51 0080

Abstract Objective To investigate the effects of adequate t otal parent eral nutrition(TPN) on cirrhotic liver. Methods Wistar rats were divided into 3 groups: normal group (n=8), cirrhotic TPN group (n=7), and cir rhotic control group (n=6). Survival rate, body weight, live/body weight ratio, nitrogen balance, liver function, hepatic triglycerin (TG) and cholesterol (CHO) , the level of portal insulin, C-peptide and glucagon were measured, and histol ogic changes of the liver were observed. Results All animals s urvived but one rat died of pneumonedema in TPN group, and body weight had not c hanged significantly. Compared with the control group, serum TBIL ,AST and ALT had not significantly changes (P>0.05), ,ALB and A/G ratio were decreased sig nificantly (P<0.05), Live r TG and CHO were increased significantly (P<0.05), the level of portal gluca gon was increased significantly (P<0.05) but portal insulin, C-peptide we re not. On the side of the degree of fatty degeneration in the liver, normal gro up was class 0, while control group and TPN group, respectively, belong to class Ⅰ and class Ⅳ. Observed by electron microscopy showed that hepatocytes have minimal lipid droplets on the control group but a lot of on the TPN group, while mitoch ondria of both groups was slight swelling. Conclusion Adequa t e TPN injuries the cirrhotic liver, and TPN also can't increased the level of se rum ALB. The further injury must prevent when adminstration TPN on cirrhotic liver and AL B infusion is advised.

     Key words Total parenteral nutrition(TPN) Cirrhosis Rat

国内外肝硬化病人全胃肠外营养(TPN)时常使用多种护肝药物和白蛋白等 ......