Buchman A L, Dubin M, Jenden D, Moukarzel A, Roch M H, Rice K, Gornbein J, Ament M E, Eckhert C D
Division of Pediatric Gastroenterology and Nutrition, UCLA Medical Center.
Gastroenterology. 1992 Apr;102(4 Pt 1):1363-70.
Plasma-free choline levels have previously been found below normal in patients receiving long term parenteral nutrition (TPN). In a group of 15 patients receiving home TPN who had low plasma free choline levels (6.3 +/- 0.8 mmol/L), we found 50% had hepatic steatosis. These patients were given oral lecithin or placebo in a double-blind randomized trial for 6 weeks. Lecithin supplementation led to an increase in plasma free choline of 53.4% +/- 15.4% at 2 weeks (P = 0.04), which continued at 6 weeks. The placebo group had no change in plasma-free choline at 2 weeks, but a significant decrease of 25.4% +/- 7.1% (P = 0.01) at 6 weeks. A significant and progressive decrease in hepatic fat was indicated by increased liver-spleen CT Hounsfield units at 2 and 6 weeks (7.5 +/- 1.7 units, P = 0.02; 13.8 +/- 3.5 units, P = 0.03) in the lecithin supplemental group. Nonsignificant changes were seen in the placebo group. It was concluded that hepatic steatosis in many patients receiving long term TPN is caused by plasma-free choline deficiency and may be reversed with lecithin supplementation. Choline is a conditionally essential nutrient in this population.
先前发现，接受长期肠外营养（TPN）的患者血浆游离胆碱水平低于正常。在一组15名接受家庭TPN且血浆游离胆碱水平较低（6.3±0.8 mmol/L）的患者中，我们发现50%的患者有肝脂肪变性。在一项双盲随机试验中，这些患者被给予口服卵磷脂或安慰剂，为期6周。补充卵磷脂导致2周时血浆游离胆碱增加53.4%±15.4%（P = 0.04），并持续至6周。安慰剂组在2周时血浆游离胆碱无变化，但在6周时显著下降25.4%±7.1%（P = 0.01）。卵磷脂补充组在2周和6周时肝脏-脾脏CT亨斯菲尔德单位增加，表明肝脂肪显著且逐渐减少（7.5±1.7单位，P = 0.02；13.8±3.5单位，P = 0.03）。安慰剂组未见显著变化。得出的结论是，许多接受长期TPN的患者的肝脂肪变性是由血浆游离胆碱缺乏引起的，补充卵磷脂可能会使其逆转。胆碱在这一人群中是一种条件必需营养素。
