腺苷甲硫氨酸对感染大鼠全肠外营养胆汁淤积的预防

目的：观察S－腺苷－L－甲硫氨酸（S－Adenothyl-L-methionine,SAMet)对感染大鼠TPN淤胆的预防效果。方法：18只体重240－280g的SD雄性大鼠随机分为三组；对照组，感染＋TP组，感染＋TPN＋SAMet组，每组各6只，后两组均结扎盲肠致感染并持续TPN支持5天。SAMet按80mg/(kg.d)加入营养液中。实验结束，胆总管插管收集胆汁，测流量，采用检测血清总胆酸（STBA）、GGT、ATLT、AKP水平，光镜、电镜下观察肝病理变化，HPLC法检测胆汁中八种结合胆直总胆盐含量。结果：感染＋TPN组与对照组比较出现胆汗流下降，STBA、GGT、AKP水平升高，病理检查见肝组织脂肪浸润、毛细胆管扩张及胆栓；而感染＋TPN＋SAMet组较感染＋TPN组胆汁流升高，STBA、GGT、ALT、AKP水平均显著下降，肝 正常或病理改变明显减轻。胆汁胆直部仅个别胆盐有差异，其余绝大部分胆盐间无显著差异。结论：在感染大鼠实施TPN时给予SAMet可有效预防TPN胆汁淤积的发生，为临床上有不停止TPN的情况下预防淤胆的发生提供了一种新的措施。

SAdenosylLMethionine prevents total parenteral nutritioninduced cholestasis in infected rats

Objectives:This study was designed to observe the effect of S adenosyl L methionine (SAMet) on total parenteral nutrition (TPN) induced cholestasis in infected rats and to analyse the change of the bile acids in the bile. Methods:18 Sprague Dawley rats were divided randomly into 3 groups,control group,infection plus TPN group,and infection plus TPN and SAMet group.Each contained 6 rats.Caecum was ligated to induce intra abdominal infection.Nutritional support was maintained for 5 days.Bile was collected by cannulating catheter.The bile flow was determined.The blood samples were gathered to measure the levels of serum total bile acid(STBA),gammaglutamyltranspeptidase (GGT),alanine aminotransferase (ALT)and alkaline phosphatase (AKP).The pathological change in the liver was observed under light microscope and electron microscope.The billiary bile acid contents were determined by high performance liquid chromatographic (HPLC) method. Results:The infection plus TPN group showed that the bile flow was reduced,levels of STBA,GGT and AKP were elevated,and fat infiltration,bile capillary dilatation and bile embolism were obvious in the liver.However,the infection plus TPN and SAMet group showed that the bile flow was increased,levels of STBA,GGT,ALT and AKP were decreased,and the liver was kept normal. Conclusions:The use of SAMet is helpful to could prevent TPN induced cholestasis in infected rats.