Effects of different types of triglycerides on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis: a prospective study

Abstract

Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/ long chain triglycerides (MCT/ LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP) . Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed. A double-blind, randomized, controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/ LCT) . All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days. The levels of alanine transaminase (ALT) , aspartate transaminase (AST) , glutamyl-transpeptidase (GGT) , alkaline phosphatase (ALP) , creatinine (Cr) , blood urea nitrogen (BUN) , triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1 , 3 and 5 after nutritional support therapy. The measurement data with normal distribution was presented as ±s. The skew distribution data were described as M (range) . The comparison between groups were evaluated with an independent sample t test or one-way ANOVA. The count data were analyzed using the chi-square test. Results A total of 30 patients were screened for eligibility. The levels of ALT, AST, GGT, ALP, Cr, BUN, TG and TC were changed within a certain range at day 1, 3 and 5 after nutritional support treatment. The levels of ALT, AST, GGT, ALP, Cr, BUN and TC before treatment and at day 5 after treatment were changed from 29. 0 U/ L, 25. 4 U/ L, 83.2 U/ L, (193 ± 115) U/ L, (124 ± 97) μmol/ L, (8 ±6) mmol/ L and (2.4 ± 1.1) mmol/ L to 29.4 U/ L, 33.0 U/ L, 77.7 U/ L, (172 ± 74) U/ L, (117 ± 103) μmol/ L, (8 ± 5) mmol/ L and (2.3 ± 1.0) mmol/ L in the experimental group, and from 23.8 U/ L, 22. 9 U/ L, 96. 2 U/ L, (148 ± 108) U/ L, (82 ± 57) μmol/ L, (9 ± 7) mmol/ L and (2.5 ± 0.7) mmol/ L to 21. 3 U/ L, 24. 5 U/ L, 127.4 U/ L, (179 ± 126) U/ L, (80 ± 54) μmol/ L, (10 ± 6) mmol/ L and (2.4 ± 0. 8 ) mmol/ L in the control group, respectively. There were no significant differences in the changing trends of the levels of ALT, AST, GGT, ALP, Cr, BUN and TC between the 2 groups (F =0.647, 1.186, 0.282, 0.553, 0.862, 0.182, 0.369, P >0.05) . The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1. 5 ± 0.6) mmol/ L to (1. 5 ± 0.7) mmol/ L, with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment. The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/ L to (2.4 ± 0. 6) mmol/ L, with increasing trend from pre-treatment to day 1 , 3 and 5 after treatments. There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F = 7.940, P <0.05) . Conclusion STG and physical mixed MCT/ LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy, while STG has a better effect of lipometabolism compared with physical mixed MCT/ LCT. Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMI16958 Key words: Acute necrotizing pancreatitis; Nutritional support therapy; Structured triglyceride; Lipometabolism