Effects of early postoperative enteral and parenteral nutrition support in cirrhotic rats after partial hepatectomy

Abstract

Objective To evaluate the impact of early enteral and parenteral nutrition support in rats with liver cirrhosis after partial hepatectomy. Methods Twenty-four rats were randomly divided into three groups in this prospective randomized control study. From postoperative day ( POD) 1 to 5, all of these groups (group A, normal EN; group B, cirrhotic EN; group C, cirrhotic PN) after receiving partial hepatectomy were nutritionally supported with equal amount of calorie [690 kj/(kg·d)] and nitrogen [1.22 g/(kg·d)] content. Moreover, on the POD 6, parameters like weight, liver function, prealbumin and transferrin were tested, as well as level of liver albumin mRNA detected by reverse transcription-poly-merase chain reaction (RT-PCR) and morphological examinations, like HE stain and immunohistochemical stain assessed by index of Ki-67 protein. Results Compared with the preoperative baseline on the POD 6, group A gained weight, but not in the other groups [group A; (6.16 ±3.28) g; group B: (5.46 ±3.59) g; groupC; (6.13 ±3.21) g,P<0.05]. The levels of serum AST, ALT and ALP after partial hepatectomy were significantly higher in groups B and C than in group A (P <0.05). Serum level of ALP was higher in group C (271 ±92) IU/L than in group B [ (209 ± 81) IU/L.P <0.05 ]. Levels of serum prealbumin and transferring were significantly declined after partial hepatectomy in groups B and C as compared with group A (P<0.05). The levels of prealbumin were significantly higher in group B (161 ±37) mg/L than in group C [ (133 ±29) mg/L.P <0.05 ]. The levels of albumin mRNA and index of Ki-67 in the murine liver were compared among these groups. Albumin mRNA was suppressed in groups B and C as compared with group A, as well as that in group C as compared with group B (A: 1.46 ±0.12; B: 1.07 ±0.14; C; 0.84 ± 0.18, P < 0.05). Index of Ki-67 was higher in group A than in groups B and C, as well as that in group B than in group C (A: 8.90 ±0.45; B: 5.60 ±0.34; C: 3.80 ±0.21 ,P <0.05). Conclusion Active nutrition support, through EN nor PN cannot efficiently promote liver regeneration and relieve liver malfunction in cirrhotic rats rather than in normal ones after partial hepatectomy, represented by delayed restoration of various parameters reflecting liver function. Nevertheless, compared with PN, standard EN revealed some advantages though. Besides reducing risk of PN-related cholestasis, EN can better the restoration by promoting protein synthesis and tissue regeneration in the postoperative liver. Key words: Liver cirrhosis; Hepatectomy; Enteral nutrition; Hepatic regeneration