1∶1 n-3/n-6多不饱和脂肪酸中心肠外营养对胃癌术后患者的疗效和安全性：一项随机对照试验

Q3 Nursing

Clinical Nutrition Open Science Pub Date : 2025-06-27 DOI:10.1016/j.nutos.2025.06.008

Ju-Hee Lee , Sang-Yong Son , Dong-Seok Han , Han Hong Lee , Hoon Hur , Seung Wan Ryu , Do Joong Park

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引用次数: 0

摘要

据报道，n -3多不饱和脂肪酸（PUFAs）具有抗炎、免疫调节和改善术后恢复等临床益处。本研究旨在探讨n-3/n-6 PUFAs比例为1:1的中央肠外营养（CPN）对胃癌切除术患者术后发病率和血脂的影响。方法60例胃癌择期胃切除术患者随机分为试验组（31例）和对照组（29例）。实验组在术后1-3天给予n-3/n-6 PUFAs与牛磺酸比例为1:1的CPN，对照组给予n-3/n-6 PUFAs比例为1:2的CPN。比较药物不良反应、总不良事件、氮平衡、炎症指标（c反应蛋白、白细胞介素-6、肿瘤坏死因子-α）、营养参数（血红蛋白、总蛋白、白蛋白、前白蛋白、转铁蛋白）、脂肪酸参数（亚油酸[LA， n-6]、花生四烯酸[n-6]、二十碳五烯酸[EPA， n-3]、二十二碳六烯酸[DHA， n-3]）。结果两组患者均未发生药物不良反应。两组间总体不良事件发生率相似。各组间营养指标和炎症指标的变化无显著差异。与对照组相比，实验组氮平衡有改善的趋势（0.63±2.37 g/d vs -1.24±4.57 g/d），但经多次比较调整后，差异无统计学意义。在测定的脂肪酸中，校正后只有EPA水平升高具有统计学意义（57.50±31.45 μg/mL vs. 35.79±14.94 μg/mL, P<0.001）。DHA水平的增加和LA增加的衰减在实验组中显示出有利的趋势，但在考虑多重检验时没有统计学意义。结论n-3/n-6 PUFAs比例为1:1的肠外营养是安全的，可能有助于改变胃癌术后患者的脂肪酸谱。需要进一步的大规模研究来验证这些发现并评估其临床意义。临床试验注册号和日期ecclinicaltrials .gov (NCT05299099)；2022年3月28日。

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Efficacy and safety of central parenteral nutrition with a 1:1 ratio of n-3/n-6 polyunsaturated fatty acids in postsurgical gastric cancer patients: A pilot randomized controlled trial

Background

N-3 polyunsaturated fatty acids (PUFAs) have been reported to exert clinical benefits including anti-inflammatory effects, immune modulation, and improved postoperative recovery. This study aimed to investigate the effects of central parenteral nutrition (CPN) with a 1:1 ratio of n-3/n-6 PUFAs on postoperative morbidity and lipid profile in gastric cancer patients undergoing gastrectomy.

Methods

Sixty gastric cancer patients undergoing elective gastrectomy were randomly assigned to the experimental (n=31) and control (n=29) groups. The experimental group received CPN with a 1:1 ratio of n-3/n-6 PUFAs and taurine during the postoperative nil-per-os period (days 1–3), while the control group received CPN with a 1:2 ratio of n-3/n-6 PUFAs. Adverse drug reactions, overall adverse events, nitrogen balance, inflammatory indicators (C-reactive protein, interleukin-6, tumor necrosis factor-α), nutrition parameters (hemoglobin, total protein, albumin, prealbumin, transferrin), and fatty acid parameters (linoleic acid [LA, n-6], arachidonic acid [n-6], eicosapentaenoic acid [EPA, n-3], docosahexaenoic acid [DHA, n-3]) were compared.

Results

No adverse drug reactions were observed in either group. Overall adverse event rates were similar between the groups. No significant differences were observed between the groups in changes in nutritional indicators or inflammatory markers. While the experimental group showed a trend toward improvement in nitrogen balance compared to the control group (0.63±2.37 vs. -1.24±4.57 g/day), this difference did not remain statistically significant after adjustment for multiple comparisons. Among the measured fatty acids, only the increase in EPA levels reached statistical significance after correction (57.50±31.45 μg/mL vs. 35.79±14.94 μg/mL, P<0.001). Increases in DHA levels and attenuation of LA increase showed favorable trends in the experimental group but were not statistically significant when accounting for multiple testing.

Conclusion

Parenteral nutrition with a 1:1 ratio of n-3/n-6 PUFAs appears to be safe and may help modify fatty acid profiles in postoperative gastric cancer patients. Further large-scale studies are needed to validate these findings and evaluate their clinical significance.