Einfluß der parenteralen Gabe von langkettigen Fettsäuren auf den Prostanoidstoffwechsel bei septischen Patienten
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Philipps-Universität Marburg
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Abstract
In this study the influence of Liposyn 20%, which
is a fat emulsion containing polyunsaturated fatty acids,
especially linoleic acid, on the eicosanoid metabolism of
septic patients was examined, while given a total parenteral
nutrition. On the septic intensive care unit of the general
hospital Augsburg a short term and a long term period study
were taken on septic patients. The short term period study took
4 days including 12 patients; the long term period study lasted
10 days including 6 patients. In each of these two stud-ies one
half of the patients were fed exclusive a mixture of
carbohydrates, while in the other group 50% of the non protein
calories were provided by Liposyn 20%. Altogether the patients
received each day 30 kcal/kg body weight as non protein
calories.In addition in each group the patients were given 100g
amino acids every day. To compare the patients regarding their
severity of disease the APACHE III?Score was determined
for each patient every day. In the eicosanoid laboratories of
the childrens hospital of the university of Marburg these
following index metabolites of the eicosanoids were measured
using gas chromatography/mass spectrometry techniques:
-
11-dehydro-TxB2 in plasma (measure for phasic
TxA2-production),
- TxB2 in 24h urin (measure for renal
TxA2-production),
- 2,3-dinor-TxB2 in 24h urin (measure for
systemic TxA2-production),
- 2,3-dinor-6-keto-PGF1a in 24h
urin (measure for systemic PGI2- production),
- PGE-M in
24h-urin (measure for systemic PGE2-production).
In addition
the contain of triglycerides and cholesterines in the plasma as
well as the contain of linoleic acid in the cholesterinesters
were determined.
Regarding the APACHE?Score there was no
difference in severity of disease between the examined
patients. In the short term period study letality in the
control group was little higher as in the group receiving fatty
acids. In the long term period study there was no difference in
letality between both groups. Triglycerides and cholesterines
were normal, which shows a good elimination and metabolism of
the given fat. All patients showed distinct increased levels of
eicosanoids. Nor in the short term nor in the long term period
study there was distinct difference in the eicosanoid
production while given Liposyn 20%. The reason for this seems
to be that during sepsis lipolysis is elevated which causes
higher liberation of arachidonic acid out of the phospholipids
of the cell membranes. This increase in liberated arachidonic
acid resulted in an increased eicosanoid production in both
groups. The additional supplementation of linoleic acid
obviously didn?t led to a rise in arachidonic acid in the group
given fatty acids, which can be explained by the rate limiting
desaturases. Certainly if given over a longer period of time
the supplementation of linoleic acid can conclude in a rise of
arachidonic acid. It seems that the periods of time chosen in
this study were obviously to short to result in this rise of
arachidonic acid. The results of this study show that
concerning the measured eicosanoids there are no reasons
against the use of long chain polyunsaturated fatty acids as
part of total parenteral nutrition for the duration of the
examined period of time.In this study the influence of Liposyn 20%, which
is a fat emulsion containing polyunsaturated fatty acids,
especially linoleic acid, on the eicosanoid metabolism of
septic patients was examined, while given a total parenteral
nutrition. On the septic intensive care unit of the general
hospital Augsburg a short term and a long term period study
were taken on septic patients. The short term period study took
4 days including 12 patients; the long term period study lasted
10 days including 6 patients. In each of these two stud-ies one
half of the patients were fed exclusive a mixture of
carbohydrates, while in the other group 50% of the non protein
calories were provided by Liposyn 20%. Altogether the patients
received each day 30 kcal/kg body weight as non protein
calories.In addition in each group the patients were given 100g
amino acids every day. To compare the patients regarding their
severity of disease the APACHE III?Score was determined
for each patient every day. In the eicosanoid laboratories of
the childrens hospital of the university of Marburg these
following index metabolites of the eicosanoids were measured
using gas chromatography/mass spectrometry techniques:
-
11-dehydro-TxB2 in plasma (measure for phasic
TxA2-production),
- TxB2 in 24h urin (measure for renal
TxA2-production),
- 2,3-dinor-TxB2 in 24h urin (measure for
systemic TxA2-production),
- 2,3-dinor-6-keto-PGF1a in 24h
urin (measure for systemic PGI2- production),
- PGE-M in
24h-urin (measure for systemic PGE2-production).
In addition
the contain of triglycerides and cholesterines in the plasma as
well as the contain of linoleic acid in the cholesterinesters
were determined.
Regarding the APACHE?Score there was no
difference in severity of disease between the examined
patients. In the short term period study letality in the
control group was little higher as in the group receiving fatty
acids. In the long term period study there was no difference in
letality between both groups. Triglycerides and cholesterines
were normal, which shows a good elimination and metabolism of
the given fat. All patients showed distinct increased levels of
eicosanoids. Nor in the short term nor in the long term period
study there was distinct difference in the eicosanoid
production while given Liposyn 20%. The reason for this seems
to be that during sepsis lipolysis is elevated which causes
higher liberation of arachidonic acid out of the phospholipids
of the cell membranes. This increase in liberated arachidonic
acid resulted in an increased eicosanoid production in both
groups. The additional supplementation of linoleic acid
obviously didn?t led to a rise in arachidonic acid in the group
given fatty acids, which can be explained by the rate limiting
desaturases. Certainly if given over a longer period of time
the supplementation of linoleic acid can conclude in a rise of
arachidonic acid. It seems that the periods of time chosen in
this study were obviously to short to result in this rise of
arachidonic acid. The results of this study show that
concerning the measured eicosanoids there are no reasons
against the use of long chain polyunsaturated fatty acids as
part of total parenteral nutrition for the duration of the
examined period of time.
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Contributors
Supervisor:
Dates
Created: 2003Issued: 2003-12-22Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
tpnpufa , sepsissirseicosanoids
DFG-subjects
UngesättigteProstaglandineParenterale ErnährungPolyenfettsäurenEicosanoideLinolsäure , Allgemeine EntzündungsreaktionSepsis
DDC-Numbers
610
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Zwingmann, Martin (12859733X): Einfluß der parenteralen Gabe von langkettigen Fettsäuren auf den Prostanoidstoffwechsel bei septischen Patienten. : Philipps-Universität Marburg 2003-12-22. DOI: https://doi.org/10.17192/z2003.0718.
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This item has been published with the following license: In Copyright