肠外鱼油单药疗法期间血小板花生四烯酸缺乏可能引起血小板功能异常

　　鱼油单药疗法是肠衰竭相关肝病（IFALD）治疗的进步。然而，这些患者存在肝脏疾病并发出血的风险，而且鱼油可以抑制血栓形成。加拿大阿尔伯塔大学、多伦多大学以前报告过新生仔猪肠外营养期间给予鱼油单药疗法的异常血小板功能，为了确定血小板异常脂肪酸组成是否可以解释先前观察到的抗血小板作用，又开展了一项新的研究。

　　该研究将新生仔猪分为两个治疗组：鱼油单药疗法肠外营养组（n=4）或大豆油肠外营养组（n=5）。在第14天，采集血浆并通过离心分离血小板。使用气液色谱法测量血浆和血小板栓的脂肪酸含量并与对照组（n=5）进行比较。

　　结果发现，鱼油组与大豆油组相比，花生四烯酸平均含量无论在血小板（3.5%比7.6%，P=0.021；对照组：4.5%～11%）还是在血浆（3.8%比9.2%，P=0.002；对照组：6.1%～9.5%）都减少一半。在肠外营养治疗期间，未见出血并发症。

　　因此，利用血小板分布图已经表明给予鱼油单药疗法的新生仔猪花生四烯酸通路血小板功能异常，本研究进一步证明血小板花生四烯酸缺乏可以解释该异常。人类婴儿肠外营养期间接受鱼油单药疗法治疗应该进行血小板分析和血小板脂肪酸分析。

JPEN J Parenter Enteral Nutr. 2016;40(4):587-91.

Platelet Arachidonic Acid Deficiency May Contribute to Abnormal Platelet Function During Parenteral Fish Oil Monotherapy in a Piglet Model.

Turner JM, Field CJ, Goruk S, Wizzard P, Dicken BJ, Bruce A, Wales PW

University of Alberta, Edmonton, Alberta, Canada; University of Toronto, Toronto, Ontario, Canada.

BACKGROUND: Fish oil monotherapy has been an advance for treating intestinal failure-associated liver disease (IFALD). However, such patients are at risk of bleeding complications from liver disease and because fish oil can inhibit thrombosis. We have previously reported abnormal platelet function in neonatal piglets given fish oil monotherapy during parenteral nutrition (PN). The purpose of this study was to determine if abnormal fatty acid composition of the platelets could explain the prior observed antiplatelet effect.

METHODS: Neonatal piglets were assigned to 2 treatments: PN with fish oil monotherapy (FO; n = 4) or PN with soy oil (SO; n = 5). On day 14, plasma was collected and platelets isolated by centrifuging. The fatty acid content in plasma and platelet plug were measured using gas liquid chromatography and compared with controls (CON; n = 5).

RESULTS: The arachidonic acid (AA) content in the FO group was on average half that of the SO group, in both the platelets (FO, 3.5% vs SO, 7.6%; P = .021; CON, 4.5%-11%) and the plasma (FO, 3.8% vs SO, 9.2%; P = .002; CON, 6.1%-9.5%). No bleeding complications were observed for any piglets during PN treatment.

CONCLUSIONS: Using platelet mapping, we have previously shown that neonatal piglets given fish oil monotherapy have abnormal platelet function in the AA pathway. This report demonstrates that such an abnormality can be explained by platelet AA deficiency. Platelet mapping and platelet fatty acid analysis should be undertaken in human infants treated with fish oil monotherapy during PN.

PMID: 25623480

DOI: 10.1177/0148607114568670