Reimund J M, Dietemann J L, Warter J M, Baumann R, Duclos B
Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France.
Clin Nutr. 2000 Oct;19(5):343-8. doi: 10.1054/clnu.2000.0120.
Home parenteral nutrition (HPN) patients often present hypermanganesamia.
To examine which factors may be associated to hypermanganesemia in HPN patients.
Plasma manganese (Mn), liver function tests, C-reactive protein concentrations, erythrocyte sedimentation rate (ESR), tumor necrosis factor-alpha (TNF- alpha), interleukin-6, soluble receptors of interleukin-2, and blood neopterin concentrations were determined in 21 HPN patients and 10 healthy controls. Brain magnetic resonance imaging (MRI) and careful neurologic clinical examination were performed in 11 patients.
Mn concentration was higher in HPN patients than controls (1.96+/-1.1 vs 0.81+/- 0.4 microg/L;P<0.001) and positively correlated to the amount of parenteral nutrition (PN) supply, transaminases and alkaline phosphatase (r=0.53, P<0.0001) concentrations, as well as to ESR (r=0.61, P<0.0001), TNF- alpha and blood neopterin. The amount of calories provided by PN was positively correlated to inflammatory markers and liver parameters. All patients investigated by MRI showed hyperintense basal ganglia on T1-weighted images suggesting brain Mn deposition. Only one had slight clinical extrapyramidal symptoms.
In HPN patients, sustained inflammation may facilitate hypermanganesemia through 1. cholestatic liver disease and thereby decreased Mn biliary excretion, 2. high nutritional requirements (responsible for increased Mn supply), and/or 3. modified Mn metabolism or body distribution. Neurologic complications appeared marginal whereas Mn brain deposition seems frequent.
家庭肠外营养（HPN）患者常出现高锰血症。
研究哪些因素可能与HPN患者的高锰血症相关。
测定了21例HPN患者和10例健康对照者的血浆锰（Mn）、肝功能指标、C反应蛋白浓度、红细胞沉降率（ESR）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6、白细胞介素-2可溶性受体和血蝶呤浓度。对11例患者进行了脑磁共振成像（MRI）检查和仔细的神经系统临床检查。
HPN患者的Mn浓度高于对照组（1.96±1.1 vs 0.81±0.4μg/L；P<0.001），且与肠外营养（PN）供应量、转氨酶和碱性磷酸酶浓度呈正相关（r=0.53，P<0.0001），也与ESR（r=0.61，P<0.0001）、TNF-α和血蝶呤呈正相关。PN提供的热量与炎症标志物和肝脏参数呈正相关。所有接受MRI检查的患者在T1加权图像上均显示基底节高信号，提示脑锰沉积。只有1例有轻微的临床锥体外系症状。
在HPN患者中，持续炎症可能通过以下方式促进高锰血症：1.胆汁淤积性肝病，从而减少锰的胆汁排泄；2.高营养需求（导致锰供应增加）；和/或3.锰代谢或体内分布改变。神经系统并发症似乎较少，而脑锰沉积似乎很常见。
