敗血症急性肺障害の免疫調整栄養
「I はじめに」 重症敗血症・大侵襲時にしばしば生じる急性肺障害は, 治療に難渋することが多く, 予後も不良である. 過剰な炎症反応を調節し臓器障害の発症を予防・軽減できる栄養素として, 魚油に含まれるω-3系多価不飽和脂肪酸(ω-3PUFA)であるエイコサペンタエン酸(EPA), ドコサヘキサエン酸(DHA), ボラージオイルに含まれるω-6系多価不飽和脂肪酸(ω-6PUFA)であるγリノレン酸(GLA)が注目され, 数多くの動物実験で, その有効性が確認されてきた. その効果はいくつかのRCTでも検証され, その有効性からさまざまなガイドラインでも信頼度と推奨度の高い栄養療法として示されて...
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| Published in | 外科と代謝・栄養 Vol. 50; no. 2; pp. 137 - 141 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本外科代謝栄養学会
2016
|
| Online Access | Get full text |
| ISSN | 0389-5564 2187-5154 |
| DOI | 10.11638/jssmn.50.2_137 |
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| Abstract | 「I はじめに」 重症敗血症・大侵襲時にしばしば生じる急性肺障害は, 治療に難渋することが多く, 予後も不良である. 過剰な炎症反応を調節し臓器障害の発症を予防・軽減できる栄養素として, 魚油に含まれるω-3系多価不飽和脂肪酸(ω-3PUFA)であるエイコサペンタエン酸(EPA), ドコサヘキサエン酸(DHA), ボラージオイルに含まれるω-6系多価不飽和脂肪酸(ω-6PUFA)であるγリノレン酸(GLA)が注目され, 数多くの動物実験で, その有効性が確認されてきた. その効果はいくつかのRCTでも検証され, その有効性からさまざまなガイドラインでも信頼度と推奨度の高い栄養療法として示されてきた. しかし, 近年の新しいRCTの結果は, これらのガイドラインの見直しを迫るものとなっている. 本稿では, 敗血症急性肺障害の治療法としてのEPA, DHA, GLAによる免疫調整栄養の意義について, 最近の知見を加えて概説する. |
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| AbstractList | 「I はじめに」 重症敗血症・大侵襲時にしばしば生じる急性肺障害は, 治療に難渋することが多く, 予後も不良である. 過剰な炎症反応を調節し臓器障害の発症を予防・軽減できる栄養素として, 魚油に含まれるω-3系多価不飽和脂肪酸(ω-3PUFA)であるエイコサペンタエン酸(EPA), ドコサヘキサエン酸(DHA), ボラージオイルに含まれるω-6系多価不飽和脂肪酸(ω-6PUFA)であるγリノレン酸(GLA)が注目され, 数多くの動物実験で, その有効性が確認されてきた. その効果はいくつかのRCTでも検証され, その有効性からさまざまなガイドラインでも信頼度と推奨度の高い栄養療法として示されてきた. しかし, 近年の新しいRCTの結果は, これらのガイドラインの見直しを迫るものとなっている. 本稿では, 敗血症急性肺障害の治療法としてのEPA, DHA, GLAによる免疫調整栄養の意義について, 最近の知見を加えて概説する. |
| Author | 深柄, 和彦 |
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| References | 3) Singer P, Theilla M, Fisher H et al.: Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med 34 (4) : 1033-1038, 2006 6) Rice TW, Wheeler AP, Thompson BT et al.: NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 306 (14) : 1574-1581, 2011 1) Gadek JE, DeMichele SJ, Karlstad MD et al.: Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 27 (8) : 1409-1420, 1999 11) Zhu D, Zhang Y, Li S et al.: Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome : a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med 40 (4) : 504-512, 2014 8) Stapleton RD, Martin TR, Weiss NS et al.: A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med 39 (7) : 1655-1662, 2011 5) Pontes-Arruda A, Demichele S, Seth A et al.: The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome : a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr 32 (6) : 596-605, 2008 4) Pontes-Arruda A, Aragão AM, Albuquerque JD : Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med 34 (9) : 2325-2333, 2006 7) Grau-Carmona T, Morán-García V, García-de-Lorenzo A et al.: Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr 30 (5) : 578-584, 2011 9) Dhaliwal R, Cahill N, Lemieux M et al.: The Canadian critical care nutrition guidelines in 2013 : an update on current recommendations and implementation strategies. Nutr Clin Pract 29 (1) : 29-43, 2014 2) Heyland DK, Dhaliwal R, Drover JW et al.: Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27 (5) : 355-373, 2003 10) McClave SA, Taylor BE, Martindale RG et al.: Society of Critical Care Medicine ; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient : Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 40 (2) : 159-211, 2016 |
| References_xml | – reference: 6) Rice TW, Wheeler AP, Thompson BT et al.: NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 306 (14) : 1574-1581, 2011 – reference: 8) Stapleton RD, Martin TR, Weiss NS et al.: A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med 39 (7) : 1655-1662, 2011 – reference: 3) Singer P, Theilla M, Fisher H et al.: Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med 34 (4) : 1033-1038, 2006 – reference: 1) Gadek JE, DeMichele SJ, Karlstad MD et al.: Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 27 (8) : 1409-1420, 1999 – reference: 4) Pontes-Arruda A, Aragão AM, Albuquerque JD : Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med 34 (9) : 2325-2333, 2006 – reference: 5) Pontes-Arruda A, Demichele S, Seth A et al.: The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome : a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr 32 (6) : 596-605, 2008 – reference: 7) Grau-Carmona T, Morán-García V, García-de-Lorenzo A et al.: Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr 30 (5) : 578-584, 2011 – reference: 2) Heyland DK, Dhaliwal R, Drover JW et al.: Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27 (5) : 355-373, 2003 – reference: 9) Dhaliwal R, Cahill N, Lemieux M et al.: The Canadian critical care nutrition guidelines in 2013 : an update on current recommendations and implementation strategies. Nutr Clin Pract 29 (1) : 29-43, 2014 – reference: 10) McClave SA, Taylor BE, Martindale RG et al.: Society of Critical Care Medicine ; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient : Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 40 (2) : 159-211, 2016 – reference: 11) Zhu D, Zhang Y, Li S et al.: Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome : a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med 40 (4) : 504-512, 2014 |
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| Title | 敗血症急性肺障害の免疫調整栄養 |
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