NO2 NO3 AND CYTOKINE PLASMA PROFILES UNDER DIFFERENT POSTOPERATIVE PARENTERAL-NUTRITION REGIMENS/

Both nitric oxide and cytokines are considered mediators of the acute- phase response in humans, and their early postoperative period plasma levels have been found to be of prognostic value. On the other hand, i t has been suggested that the fatty emulsions used in total parenteral nutrition (TPN) may induce changes in macrophage function. In the pre sent study we investigated the postoperative evolution of tumor necros is factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-6 (IL-6 ), and nitrate/nitrite plasma levels under three different TPN regimen s. Twenty-one patients diagnosed with upper digestive tract neoplasm, without preoperative TPN, and having undergone radical surgery, were r andomly assigned to three groups: Group I, all nonprotein calories sup plied by hypertonic glucose solution; Group II, 55% of the nonprotein calories supplied by glucose and 45% by 20% long-chain triacylglycerid es emulsion (LCT) (Intralipid 20%, Kabi-Pharmacia); Group III, same as Group II, but a 20% emulsion of a mixture of medium-chain and long-ch ain triacylglycerides (MCT/LCT) (Lipofundina MCT/LCT 20%, B. Braun) wa s used instead of LCT. Blood samples were obtained on postoperative Da ys 1-5 and 10, 3 h after ending the lipid infusion. In all the three g roups IL-1, IL-6, and TNF-alpha levels rose after surgery, peaking at Day 2, whereas NO2/NO3 levels had their peak at Day 3. Day-to-day comp arison of plasma levels of cytokines and NO2/NO2 between the investiga ted groups did not show any statistical significance. Differences betw een group means were not found when the areas under the curve over the first 5 postoperative days were compared (1.72 +/- 0.25, Group I; 1.8 8 +/- 0.34, Group II; and 2.52 +/- 0.50, Group III, for TNF-alpha; 1.7 9 +/- 0.12, Group I; 1.92 +/- 0.18, Group II; and 1.50 +/- 0.12, Group III, for NO2/NO3). We conclude that the different parenteral nutritio n regimens studied do not evoke alterations in cytokine and NO2 + NO3 levels in the patient groups investigated in this study.