Kruger Pamela C, Parsons Patrick J, Galusha Aubrey L, Morrissette Michelle, Recker Robert R, Howard Lyn J
Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York.
Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, New York
JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):728-35. doi: 10.1177/0148607113491981. Epub 2013 Jun 13.
Aluminum (Al) contamination of parenteral nutrition (PN) solutions remains a concern for long-term PN patients. Al accumulates particularly in bone. Excessive exposure to Al may result in increased Al body burden and impaired bone formation and mineralization, leading to bone disease. Although the U.S. Food and Drug Administration (FDA) has limited Al contamination in large-volume parenteral solutions, small-volume parenterals may still contribute considerable amounts of Al to PN solutions. The goal of this study is to determine whether or not long-term adult PN patients remain at risk for increased bone Al accumulation.
We measured Al accumulation in autopsy bones from 7 patients who had received PN for 2-21 years and compared bone Al levels with those in living control patients undergoing hip or knee replacement. Electrothermal atomic absorption spectrometry was used for bone Al measurements.
When compared with bone Al content in controls, markedly elevated Al levels (P < .0001) were found in the bones of all but 1 patient, who received PN for only 2 years before death. Even greater Al accumulation was found for PN patients who developed late renal impairment (P = .0159).
We conclude that long-term adult PN patients continue to be at risk for Al toxicity.
肠外营养（PN）溶液中的铝（Al）污染仍是长期接受PN治疗患者所关注的问题。铝尤其会在骨骼中蓄积。过量接触铝可能导致体内铝负荷增加以及骨形成和矿化受损，进而引发骨病。尽管美国食品药品监督管理局（FDA）已对大容量肠外溶液中的铝污染进行了限制，但小容量肠外制剂仍可能向PN溶液中贡献大量的铝。本研究的目的是确定长期接受PN治疗的成年患者是否仍面临骨铝蓄积增加的风险。
我们测量了7例接受PN治疗2至21年患者尸检骨骼中的铝蓄积情况，并将骨骼铝水平与接受髋关节或膝关节置换术的对照活体患者进行比较。采用电热原子吸收光谱法测量骨骼中的铝含量。
与对照组的骨骼铝含量相比，除1例在死亡前仅接受2年PN治疗的患者外，所有患者骨骼中的铝水平均显著升高（P <.0001）。对于出现晚期肾功能损害的PN患者，铝蓄积更为明显（P =.0159）。
我们得出结论，长期接受PN治疗的成年患者仍面临铝中毒的风险。
