Llop Josep M, Virgili Núria, Moreno-Villares José M, García-Peris Pilar, Serrano Teresa, Forga Maria, Solanich Joan, Pita Ana M
Department of Pharmacy and Endocrinology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain.
Nutrition. 2008 Nov-Dec;24(11-12):1145-52. doi: 10.1016/j.nut.2008.06.017. Epub 2008 Jul 24.
Phytosterols present in parenteral nutrition (PN) lipid emulsions have been linked to phytosterolemia and cholestatic liver disease, although no direct relation has been established. We investigated the relation among plasma phytosterol (PY) infused, total plasma PY levels, and possible links to PN-associated liver disease.
Twenty-seven adult patients on home PN were enrolled in the study. PYs were measured in plasma and lipid emulsions by gas chromatography. Liver function tests and blood counts were assessed to identify hepatic impairment, and biopsies were performed in eight patients.
Mean total plasma PY level was higher in patients than in controls (55.4 +/- 6.2 versus 14.8 +/- 2.3 microg/mL). Simple linear regression models showed a correlation among total plasma PY, liver function tests, and platelet counts, which was stronger for total bilirubin (r(2) = 0.53, P = 0.0001) and aspartate aminotransferase (r(2) = 0.50, P = 0.0001) and weaker for platelet counts (r(2) = 0.158, P = 0.04); between infused lipid and liver function tests, the correlation was significant for total bilirubin (r(2) = 0.19, P = 0.038) and aspartate aminotransferase (r(2) = 0.164, P = 0.049). In multiple linear regression analysis, a decreased oral diet (b = -52.3, P = 0.001) and infused PY (b = 2.54, P = 0.093) were risk factors for high plasma PY levels (r(2) = 0.54). Biopsies showed moderate to severe liver impairment in five patients.
Liver damage may be linked to high plasma PY levels and strengthened by lack of an oral diet in patients on home PN.
肠外营养（PN）脂质乳剂中存在的植物甾醇与植物甾醇血症和胆汁淤积性肝病有关，尽管尚未建立直接关联。我们研究了输注的血浆植物甾醇（PY）、血浆总PY水平之间的关系，以及与PN相关肝病的可能联系。
27名接受家庭PN的成年患者纳入本研究。通过气相色谱法测量血浆和脂质乳剂中的PY。评估肝功能测试和血细胞计数以识别肝损伤，并对8名患者进行活检。
患者的平均血浆总PY水平高于对照组（55.4±6.2对14.8±2.3微克/毫升）。简单线性回归模型显示血浆总PY、肝功能测试和血小板计数之间存在相关性，总胆红素（r² = 0.53，P = 0.0001）和天冬氨酸转氨酶（r² = 0.50，P = 0.0001）的相关性更强，血小板计数的相关性较弱（r² = 0.158，P = 0.04）；在输注的脂质与肝功能测试之间，总胆红素（r² = 0.19，P = 0.038）和天冬氨酸转氨酶（r² = 0.164，P = 0.049）的相关性显著。在多元线性回归分析中，口服饮食减少（b = -52.3，P = 0.001）和输注的PY（b = 2.54，P = 0.093）是血浆PY水平升高的危险因素（r² = 0.54）。活检显示5名患者有中度至重度肝损伤。
肝损伤可能与血浆PY水平升高有关，并且家庭PN患者缺乏口服饮食会加剧这种情况。
