Sluijter P P, Droop A, Timmer J G, Romijn J A, Strack van Schijndel R J, Sauerwein H P
Afd. Inwendige Geneeskunde, Academisch Medisch Centrum/Universiteit van Amsterdam.
Ned Tijdschr Geneeskd. 1999 Jun 19;143(25):1314-8.
Parenteral nutrition is associated with liver enzyme abnormalities. Until 1993 the incidence of icterus was low in both academic hospitals in Amsterdam, the Netherlands (Academic Medical Centre (AMC) and Academic Hospital of the Free University (AZVU)). In 1993 Intralipid in the nutrition was replaced by Endolipid in the home total parenteral nutrition programme (AMC) and by Lipofundin S in AZVU. Fifty per cent of the patients in the home programme developed severe fatigue, jaundice and thrombocytopenia. These signs and symptoms disappeared over months when parenteral nutrition without fat was given. After reintroduction of Intralipid these signs and symptoms never recurred. In AZVU the incidence of jaundice increased from 21% in 1992 to 79% in 1993 (p = 0.0002). After reintroduction of Intralipid in 1994 the incidence of jaundice decreased to 16%.
Although the lipid emulsions are equivalent according to the product specification, the described observation suggests that Lipofundin S and Endolipid cause more icterus than Intralipid, possibly caused bij an impurity in the fat emulsion.
肠外营养与肝酶异常有关。直到1993年，荷兰阿姆斯特丹的两家学术医院（学术医疗中心（AMC）和自由大学学术医院（AZVU））黄疸发生率都很低。1993年，家庭全肠外营养计划（AMC）中营养制剂里的英脱利匹特被恩多力匹特取代，在AZVU则被力保肪宁S取代。家庭计划中50%的患者出现严重疲劳、黄疸和血小板减少。当给予无脂肪的肠外营养时，这些体征和症状在数月内消失。重新引入英脱利匹特后，这些体征和症状再也没有复发。在AZVU，黄疸发生率从1992年的21%升至1993年的79%（p = 0.0002）。1994年重新引入英脱利匹特后，黄疸发生率降至16%。
尽管根据产品规格脂质乳剂是等效的，但上述观察结果表明，力保肪宁S和恩多力匹特比英脱利匹特导致更多黄疸，可能是由脂肪乳剂中的杂质引起的。
