Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 E Zhongshan Rd, Nanjing 210002, PR China.
Clin Nutr. 2012 Apr;31(2):217-23. doi: 10.1016/j.clnu.2011.10.001. Epub 2011 Oct 27.
BACKGROUND & AIMS: Parenteral nutrition-associated liver disease (PNALD) complicates the treatment of patients with short bowel syndrome (SBS). Some studies have shown omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have favorable effects in treating PNALD in children. We, therefore, investigate the effects of ω-3 PUFAs supplemented intravenous lipid emulsion (ILE) on PNALD in adults.
We performed an open-labeled study of a ω-3 PUFAs based ILE in 15 adults with SBS who developed cholestasis while receiving soybean oil-based ILE. Liver biopsies were performed before and after the initiation of ω-3 PUFAs to confirm the presence and improvement of cholestasis. Blood samples were collected every week for analysis of fatty acid composition and liver function.
12 of the 15 patients had their direct bilirubin normalized within 4 weeks and our data demonstrated a significant decrease in both DB (P ≤ 0.001) and TB (P ≤ 0.001) after 4 weeks compared to baseline. There were ameliorations of liver function and fatty acid patterns in all patients and serial liver biopsy specimens showed progressive histologic improvement.
Parenteral ω-3 PUFAs supplemented fat emulsions are safe and effective in the treatment of PNALD in adults.
肠外营养相关肝病（PNALD）会使短肠综合征（SBS）患者的治疗复杂化。一些研究表明ω-3 多不饱和脂肪酸（ω-3 PUFAs）对治疗儿童 PNALD 有良好的效果。因此，我们研究了ω-3 PUFAs 补充静脉脂乳剂（ILE）对成人 PNALD 的影响。
我们对 15 名接受大豆油基 ILE 治疗时发生胆汁淤积的 SBS 成人进行了一项 ω-3 PUFAs 基础 ILE 的开放性研究。在开始使用 ω-3 PUFAs 之前和之后进行肝活检，以确认是否存在并改善胆汁淤积。每周采集血样进行脂肪酸组成和肝功能分析。
15 例患者中有 12 例直接胆红素在 4 周内恢复正常，与基线相比，我们的数据显示，4 周后 DB（P ≤ 0.001）和 TB（P ≤ 0.001）均显著降低。所有患者的肝功能和脂肪酸模式均得到改善，连续肝活检标本显示组织学逐渐改善。
肠外 ω-3 PUFAs 补充脂肪乳剂治疗成人 PNALD 安全有效。
