Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
Am J Clin Nutr. 2013 Aug;98(2):312-8. doi: 10.3945/ajcn.112.056556. Epub 2013 Jun 12.
Elevated plasma phytosterol concentrations are an untoward effect of parenteral nutrition (PN) with vegetable oil-based lipid emulsions (LEs). Phytosterols are elevated in neonatal cholestasis, but the relation remains controversial.
The objective was to study the effect of 5 LEs on plasma phytosterols in preterm infants.
One hundred forty-four consecutive admitted preterm infants (birth weight: 500-1249 g) were studied. Patients were randomly assigned to receive 1 of 5 different LEs: S [100% soybean oil (SO)], MS [50% medium-chain triglycerides (MCTs) and 50% SO], MSF (50% MCTs, 40% SO, and 10% fish oil (FO)], OS (80% olive oil and 20% SO), or MOSF (30% MCTs, 25% olive oil, 30% SO, and 15% FO). Phytosterols in the LEs and in plasma (on postnatal day 7 and day 14) were measured by gas chromatography-mass spectrometry.
Patients in the S group had significantly higher total phytosterol intakes than did the other study groups. On PN days 7 and 14, plasma phytosterol concentrations were highest in the S group and lowest in the MOSF group. Despite similar β-sitosterol intakes between the MS and MSF groups, plasma concentrations were significantly lower in the MSF than in the MS group. Only 3 patients (2.1%) developed cholestasis: 1 in the MS, 1 in the MSF, and 1 in the MOSF group. No cases of cholestasis were observed in the S and OS groups.
In uncomplicated preterm infants receiving routine PN, we found a correlation between phytosterol intake and plasma phytosterol concentrations; however, cholestasis was rare and no difference in liver function at 6 wk was observed.
以植物油为基础的脂肪乳剂（LE）的肠外营养（PN）会导致血浆植物固醇浓度升高，这是一种不良反应。植物固醇在新生儿胆汁淤积症中升高，但这种关系仍存在争议。
本研究旨在研究 5 种 LE 对早产儿血浆植物固醇的影响。
本研究纳入了 144 例连续入院的早产儿（出生体重：500-1249g）。患者被随机分配接受以下 5 种不同 LE 中的 1 种：S（100%大豆油[SO]）、MS（50%中链甘油三酯[MCTs]和 50%SO）、MSF（50%MCTs、40%SO 和 10%鱼油[FO]）、OS（80%橄榄油和 20%SO）或 MOSF（30%MCTs、25%橄榄油、30%SO 和 15%FO）。通过气相色谱-质谱法测量 LE 和血浆中的植物固醇（在出生后第 7 天和第 14 天）。
S 组患者的总植物固醇摄入量明显高于其他研究组。在 PN 第 7 天和第 14 天，S 组的血浆植物固醇浓度最高，MOSF 组最低。尽管 MS 组和 MSF 组的β-谷固醇摄入量相似，但 MSF 组的血浆浓度明显低于 MS 组。只有 3 名患者（2.1%）发生胆汁淤积：1 名在 MS 组，1 名在 MSF 组，1 名在 MOSF 组。在 S 组和 OS 组未观察到胆汁淤积病例。
在接受常规 PN 的无并发症早产儿中，我们发现植物固醇摄入量与血浆植物固醇浓度之间存在相关性；然而，胆汁淤积很少见，6 周时肝功能无差异。
