Forchielli Maria Luisa, Walker W Allan
Department of Pediatrics, University of Bologna, Bologna, Italy.
Adv Pediatr. 2003;50:245-67.
Parenteral nutrition-associated cholestasis is a major clinical problem in pediatrics, particularly during infancy in children with short bowel syndrome who require long-term use of total parenteral nutrition (TPN) for survival. Multifactorial theories regarding the origin of parenteral nutrition-associated cholestasis have not yet defined its pathogenesis or resulted in a solution to the problem. However, our knowledge of risk factors has helped develop new hypotheses as to the mechanisms of this disease. In this review, we consider the following potential risk factors that influence the development of this condition: (1) the gastrointestinal dysfunction associated with the absence of enteric nutrients while receiving TPN; (2) components of TPN solutions as potential hepatotoxins; and (3) the contribution of the underlying disease necessitating TPN for adequate nutrition. It is hoped that a better understanding of factors affecting hepatocyte secretion and bile formation and flow will help to prevent this life-threatening complication of TPN.
肠外营养相关胆汁淤积是儿科的一个主要临床问题，尤其是在患有短肠综合征的婴儿期儿童中，这些儿童需要长期使用全肠外营养（TPN）以维持生命。关于肠外营养相关胆汁淤积起源的多因素理论尚未明确其发病机制，也未找到解决该问题的方法。然而，我们对危险因素的了解有助于提出关于该疾病机制的新假设。在本综述中，我们考虑以下影响该疾病发生发展的潜在危险因素：（1）接受TPN时与缺乏肠内营养相关的胃肠功能障碍；（2）TPN溶液成分作为潜在肝毒素；（3）需要TPN以获得充足营养的基础疾病的影响。希望更好地了解影响肝细胞分泌、胆汁形成和流动的因素，将有助于预防TPN这种危及生命的并发症。
