Effect of ω-3 polyunsaturated fatty acids on intestinal mucosal barrier of patients with severe acute pancreatitis

Abstract

Objective To study the influence of ω-3 polyunsaturated fatty acids on the serum D-lactate level,diamine oxidase (DAO) activity and urinary lactulose/mannitol (L/M) ratio in patients with severe acute pancreatitis (SAP).Methods A total of 40 SAP patients were enrolled from August 2012 to May 2014 in departments of general surgery of First Hospital of Shanxi Medical University and People's Hospital of Dancheng,Henan.The patients were randomly assigned into research group (n =20) and control group (n =20) using SAS 8.0 statistics software.The control group was given conventional parenteral nutrition (PN) support,while in the research group,fish oil fat emulsion (rich in ω-3 polyunsaturated fatty acids) was used instead of structured triglyceride emulsion.The changes of serum D-lactate level,DAO activity,and urinary L/M ratio were observed on the day of admission,and the 1st,5th,10th day of PN support.Results The serum D-lactate level,DAO activity and urinary L/M ratio of both groups were found decreased after PN.Upon admission and the on the 1 st day of PN,no significant differences were noted between the research group and the control group in the serum D-lactate level [(7.47±0.72) mng/Lvs.(7.31 ±0.54) mg/L,F=0.677,P=0.416; (7.370.68) mg/Lvs.(7.35± 0.59) mg/L,F =0.014,P =0.908],DAO activity [(16.99 ±0.93) U/L vs.(16.83 ±0.82) U/L,F=0.314,P=0.579; (17.12±0.77) U/Lvs.(17.07 ±0.68) U/L,F=0.068,P=0.796] and urinary L/M (0.23 ±0.07 vs.0.22±0.07,F=0.091,P =0.765 ; 0.21± 0.07 vs.0.22±0.08,F=0.119,P=0.732).On the 5th and 10th day of PN,the research group showed significantly lower compared with the control group:serum D-lactate level [(5.62 ±0.34) mg/L vs.(6.61 ±0.30) mg/L,F=95.242,P=0.000; (2.76±0.55) mg/L vs.(4.56±0.37) mg/L,F=148.052,P=0.000],DAO activity [(7.02 ± 0.93) U/Lvs.(10.40 ±0.68) U/L,F=170.815,P =0.000; (3.32±0.80) U/L vs.(6.09± 0.69) U/L,F=138.645,P=0.000],and urinary L/M (0.57±0.08 vs.0.82±0.07,F=112.668,P=0.000; 0.19±0.12 vs.0.27 ±0.08,F=6.551,P=0.015).Conclusion Clinical application offish oil emulsion rich in ω-3 polyunsaturated fatty acids in the treatment of SAP can significantly reduce the serum D-lactate level,DAO activity and urinary L/M ratio,suggesting the protective effect of ω-3 polyunsaturated fatty acids on the functional integrity of intestinal mucosal barrier. Key words: Severe acute pancreatitis; ω-3 polyunsaturated fatty acids; Intestinal mucosal barrier; D-lactate ; Diamine oxidase; Lactulose/mannitol