Buchman A L, Sohel M, Brown M, Jenden D J, Ahn C, Roch M, Brawley T L
Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois 60611, USA.
JPEN J Parenter Enteral Nutr. 2001 Jan-Feb;25(1):30-5. doi: 10.1177/014860710102500130.
Previous investigations have demonstrated that choline deficiency, manifested in low plasma-free choline concentration and hepatic injury, may develop in patients who require long-term total parenteral nutrition (TPN). Preliminary studies have suggested lecithin or choline supplementation might lead to improved visual memory in the elderly and reverse abnormal neuropsychological development in children. We sought to determine if choline-supplemented TPN would lead to improvement in neuropsychological test scores in a group of adult, choline-deficient outpatients receiving TPN.
Eleven subjects (8 males, 3 females) who received nightly TPN for more than 80% of their nutritional needs for at least 12 weeks before entry in the study were enrolled. Exclusion criteria included active drug abuse, mental retardation, cerebral vascular accident, head trauma, hemodialysis or peritoneal dialysis, (prothrombin time [PT] >2x control), or acquired immune deficiency syndrome (AIDS). Patients were randomly assigned to receive their usual TPN regimen (n = 6, aged 34.0 +/- 12.6 years) over a 12-hour nightly infusion or their usual TPN regimen plus choline chloride (2 g) (n = 5, aged 37.3 +/- 7.3 years). The following neuropsychological tests were administered at baseline and after 24 weeks of choline supplementation (or placebo): Weschler Adult Intelligence Scale-Revised (WAIS-R, intellectual functioning), Weschler Memory Scale-Revised (WMS-R, two subtests, verbal and visual memory), Rey-Osterrieth Complex Figure Test (visuospatial functioning and perceptual organization), Controlled Oral Word Association Test (verbal fluency), Grooved Pegboard (manual dexterity and motor speed), California Verbal Learning Test (CVLT, rote verbal learning ability), and Trail Making Parts A & B (visual scanning, psychomotor speed and set shifting). Scores were reported in terms of standard scores including z scores and percentile ranks. Mean absolute changes in raw scores were compared between groups using the Wilcoxon rank sum test, where p values < .05 constituted statistical significance.
Significant improvements were found in the delayed visual recall of the WMS-R (7.0 +/- 2.7 vs -.33 +/- 5.7, p = .028), and borderline improvements in the List B subset of the CVLT (1.0 +/- 0.8 vs -2.0 +/- 2.4, p = .06) and the Trails A test (-3.8 +/- 8.1 vs 3.7 +/- 4.5 seconds, p = .067). No other statistically significant changes were seen.
This pilot study indicates both verbal and visual memory may be impaired in patients who require long-term TPN and both may be improved with choline supplementation.
先前的研究表明，在需要长期全胃肠外营养（TPN）的患者中，可能会出现以血浆游离胆碱浓度降低和肝损伤为表现的胆碱缺乏症。初步研究表明，补充卵磷脂或胆碱可能会改善老年人的视觉记忆，并逆转儿童异常的神经心理发育。我们试图确定补充胆碱的TPN是否会使一组接受TPN的成年胆碱缺乏门诊患者的神经心理测试分数得到改善。
招募了11名受试者（8名男性，3名女性），他们在进入研究前至少12周内每晚接受TPN，其营养需求的80%以上通过TPN提供。排除标准包括药物滥用、智力低下、脑血管意外、头部外伤、血液透析或腹膜透析（凝血酶原时间[PT]>对照值的2倍）或获得性免疫缺陷综合征（AIDS）。患者被随机分配接受每晚12小时的常规TPN方案（n = 6，年龄34.0±12.6岁）或常规TPN方案加氯化胆碱（2 g）（n = 5，年龄37.3±7.3岁）。在基线时以及补充胆碱（或安慰剂）24周后进行以下神经心理测试：韦氏成人智力量表修订版（WAIS-R，智力功能）、韦氏记忆量表修订版（WMS-R，两个子测试，言语和视觉记忆）、雷-奥斯特里思复杂图形测试（视觉空间功能和知觉组织）、受控口语单词联想测试（言语流畅性）、沟槽钉板测试（手部灵巧性和运动速度）、加利福尼亚言语学习测试（CVLT，机械言语学习能力）以及连线测验A和B部分（视觉扫描、心理运动速度和定势转换）。分数以标准分数报告，包括z分数和百分等级。使用Wilcoxon秩和检验比较两组原始分数的平均绝对变化，p值<0.05具有统计学意义。
在WMS-R的延迟视觉回忆方面发现了显著改善（7.0±2.7对-0.33±5.7，p = 0.028），CVLT的B表子集（1.0±0.8对-2.0±2.4，p = 0.06）和连线测验A部分（-3.8±8.1对3.7±4.5秒，p = 0.067）有临界改善。未观察到其他具有统计学意义的变化。
这项初步研究表明，需要长期TPN的患者的言语和视觉记忆可能受损，补充胆碱可能会改善这两者。
