Buchman Alan L, Iyer Kishore, Fryer Jonathan
Division of Gastroenterology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Hepatology. 2006 Jan;43(1):9-19. doi: 10.1002/hep.20997.
Parenteral nutrition-associated liver disease (PNALD) is the most devastating complication of long-term parenteral nutrition therapy. Because its progression is typically insidious and its long-term consequences are generally underappreciated, PNALD is often recognized too late, when liver injury is irreversible. When end-stage liver disease (ESLD) develops in these patients, most potential interventions are futile and transplantation of both an intestine and a liver becomes the only viable option, despite the relatively poor outcomes associated with this combined procedure. Although likely multifactorial in origin, the etiology of PNALD is poorly understood. Early clinical intervention with a combination of nutritional, medical, hormonal, and surgical therapies can be effective in preventing liver disease progression. If these interventions fail, intestinal transplantation should be performed expeditiously before development of ESLD mandates simultaneous inclusion of a liver graft as well.
肠外营养相关肝病（PNALD）是长期肠外营养治疗最严重的并发症。由于其进展通常较为隐匿，且其长期后果往往未得到充分重视，PNALD常常在肝脏损伤不可逆转时才被发现，为时已晚。当这些患者发展为终末期肝病（ESLD）时，大多数潜在的干预措施都徒劳无功，尽管联合进行肠和肝移植的预后相对较差，但这成为唯一可行的选择。尽管PNALD的病因可能是多因素的，但其病因仍知之甚少。早期采用营养、药物、激素和手术治疗相结合的临床干预措施可有效预防肝病进展。如果这些干预措施失败，应在ESLD发展到需要同时进行肝移植之前迅速进行肠移植。
