论文部分内容阅读
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。
Objective To investigate the effect of rational total parenteral nutrition (TPN) on cirrhotic liver in order to prevent and treat TPN-related complications. Methods Wistar rats were divided into 3 groups: 8 in normal group, 6 in cirrhosis control group and 7 in cirrhotic TPN group. The survival of rats was observed. The changes of body weight and liver weight / body weight ratio in rats before and after the experiment were observed. The nitrogen balance, hepatic function, triglyceride (TG), cholesterol (CHO) , C-peptide, changes in glucagon concentration, and changes in liver histopathology. Results All the rats in the TPN group survived after infusion of too much fluid and pulmonary edema. There was no significant change in body weight before and after the experiment. Compared with the control group, the levels of serum TBIL, AST and ALT in TPN group were not significantly different (P> 0.05), the ALB and A / G ratios were significantly decreased (P <0.05) P <0.05). The concentrations of insulin and C-peptide in portal vein were not significantly increased, but glucagon concentration was significantly increased (P <0.05). Hepatic steatosis, normal group 0, control group Ⅰ, TPN group Ⅳ. Electron microscopy showed that there was a small amount of lipid droplets in the cytoplasm of liver cytoplasm, while there was a large amount of fat droplets in TPN group. Mitochondria were slightly swollen in both groups. CONCLUSIONS: Reasonable TPN is still damaging to hardened liver, and TPN also fails to increase serum albumin concentration. Therefore, further hepatic damage must be prevented and treated when TPN is hardened and must be enhanced with albumin.