Javid Patrick J, Greene Arin K, Garza Jenna, Gura Kathleen, Alwayn Ian P J, Voss Stephen, Nose Vania, Satchi-Fainaro Ronit, Zausche Blanca, Mulkern Robert V, Jaksic Tom, Bistrian Bruce, Folkman Judah, Puder Mark
Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
J Pediatr Surg. 2005 Sep;40(9):1446-53. doi: 10.1016/j.jpedsurg.2005.05.045.
The etiology of parenteral nutrition (PN)-associated hepatic injury remains unresolved. Recent studies have suggested that the intravenous (IV) lipid emulsion administered with PN may contribute to PN-associated hepatic injury. We therefore examined whether the route of lipid administration would affect the development of PN-associated liver injury in a previously established animal model of PN-induced hepatic steatosis.
Mice were fed ad libitum PN solution as their only nutritional source for 19 days with lipid supplementation by either the enteral or the IV route. Control mice received chow alone, and a final group received enteral PN solution without lipid supplementation.
All mice gained equivalent weight during the study. Mice receiving PN alone or PN with IV lipid developed severe histologic liver damage that was not seen in control mice or in mice receiving PN with enteral lipid. Liver fat content as measured by magnetic resonance spectroscopy was significantly lower in the control and enteral lipid groups when compared with mice receiving PN alone or with IV lipid. Mice receiving enteral lipid had significantly lower levels of serum aspartate aminotransferase and alanine aminotransferase compared with animals receiving PN alone.
These data provide preliminary evidence that lipid administered through the enteral route protects against PN-associated hepatic injury in an animal model.
肠外营养(PN)相关肝损伤的病因仍未明确。近期研究表明,与PN一同给予的静脉(IV)脂肪乳剂可能导致PN相关肝损伤。因此,我们在先前建立的PN诱导肝脂肪变性动物模型中,研究了脂肪给药途径是否会影响PN相关肝损伤的发生发展。
小鼠随意进食PN溶液作为其唯一营养来源,为期19天,通过肠内或静脉途径补充脂肪。对照小鼠仅给予普通饲料,最后一组给予不含脂肪补充剂的肠内PN溶液。
在研究期间,所有小鼠体重增加相当。单独接受PN或接受静脉脂肪PN的小鼠出现了严重的组织学肝损伤,而对照小鼠或接受肠内脂肪PN的小鼠未出现这种情况。与单独接受PN或静脉脂肪PN的小鼠相比,通过磁共振波谱测量,对照和肠内脂肪组的肝脏脂肪含量显著更低。与单独接受PN的动物相比,接受肠内脂肪的小鼠血清天冬氨酸转氨酶和丙氨酸转氨酶水平显著更低。
这些数据提供了初步证据,表明在动物模型中,通过肠内途径给予脂肪可预防PN相关肝损伤。