Klein G L
J Parenter Sci Technol. 1989 May-Jun;43(3):120-4.
Bone abnormalities may complicate parenteral nutrition (PN) therapy given to patients. Bone disease, manifested by reduced bone formation and demineralization in adults, and poor mineralization in infants, is associated with bone aluminum accumulation at the mineralizing surface. Aluminum was first shown to contaminate casein hydrolysate, the PN protein source. Substitution of amino acid solutions, low in aluminum, reduced bone aluminum and improved bone formation in adults. Aluminum also accumulates ten-fold in the bones of premature infants receiving chronic PN. Present sources of aluminum in PN are calcium and phosphate salts, albumin, and heparin. Although increased bone aluminum in infants is not proven to cause disease, use of deferoxamine in one infant produced hypocalcemia. This suggested that chelation of bone aluminum by deferoxamine increased bone calcium uptake. Thus aluminum in bone may impair bone calcium uptake and may contribute to the pathogenesis of PN-related bone disease in infants. Another complication of PN therapy in infants is cholestatic liver disease, manifested by reduced bile flow, and, occasionally, gallstones. Aluminum has been found to accumulate in the livers of these infants, and there is experimental evidence that aluminum can reduce bile flow both in rats and in piglets. Aluminum contamination of PN solutions puts infants at increased risk for complications of PN therapy; amounts of aluminum in PN solutions should therefore be minimized.
骨异常可能会使接受肠外营养（PN）治疗的患者病情复杂化。骨病在成人中表现为骨形成减少和脱矿质，在婴儿中表现为矿化不良，这与矿化表面的骨铝蓄积有关。铝最初被发现会污染PN蛋白质来源酪蛋白水解物。用低铝氨基酸溶液替代，可减少成人骨铝含量并改善骨形成。接受长期PN的早产儿骨骼中的铝蓄积量也会增加10倍。PN中铝的当前来源是钙盐、磷酸盐、白蛋白和肝素。虽然婴儿骨铝增加尚未被证实会导致疾病，但在一名婴儿中使用去铁胺导致了低钙血症。这表明去铁胺对骨铝的螯合增加了骨钙摄取。因此，骨中的铝可能会损害骨钙摄取，并可能导致婴儿PN相关骨病的发病机制。婴儿PN治疗的另一个并发症是胆汁淤积性肝病，表现为胆汁流量减少，偶尔还会出现胆结石。已发现铝在这些婴儿的肝脏中蓄积，并且有实验证据表明铝可减少大鼠和仔猪的胆汁流量。PN溶液中的铝污染会使婴儿发生PN治疗并发症的风险增加；因此，应尽量减少PN溶液中的铝含量。
