静脉用鱼油与儿科肠衰竭相关肝病：血浆植物甾醇、细胞因子和胆汁酸以及红细胞脂肪酸的变化。
Intravenous Fish Oil and Pediatric Intestinal Failure-Associated Liver Disease: Changes in Plasma Phytosterols, Cytokines, and Bile Acids and Erythrocyte Fatty Acids.
机构信息
Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, and Mattel Children's Hospital at UCLA, Los Angeles, California, USA.
Department of Physiology and Pharmacology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
出版信息
JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):633-641. doi: 10.1177/0148607117709196. Epub 2017 Dec 18.
BACKGROUND
Soybean oil (SO) emulsions are associated with intestinal failure-associated liver disease (IFALD); fish oil (FO) emulsions are used to treat IFALD. SO and FO differ with respect to their fatty acid and phytosterol content. In children with IFALD whose SO was replaced with FO, we aimed to (1) quantify changes in erythrocyte fatty acids and plasma phytosterols, cytokines, and bile acids and (2) correlate these changes with direct bilirubin (DB).
DESIGN
This study enrolled IFALD children who received 6 months of FO. Blood samples were collected prior to FO, and after 2 weeks and 3 and 6 months of FO. The primary outcome was 3-month vs baseline biomarker concentrations.
RESULTS
At study initiation, the median patient age was 3 months (interquartile range, 3-17 months), and mean ± standard deviation DB was 5.6 ± 0.7 mg/dL (n = 14). Cholestasis reversed in 79% of subjects. Eicosapentaenoic and docosahexaenoic acid was greater than baseline (P < .001, all time points). Linoleic and arachidonic acid and sitosterol and stigmasterol were less than baseline (P < .05, all time points). Three- and 6-month interleukin-8 (IL-8) and total and conjugated bile acids were less than baseline (P < .05). Baseline IL-8 was correlated with baseline DB (r = 0.71, P < .01). Early changes in stigmasterol and IL-8 were correlated with later DB changes (r = 0.68 and 0.75, P < .05).
CONCLUSION
Specific fat emulsion components may play a role in IFALD. Stigmasterol and IL-8 may predict FO treatment response.
背景
大豆油（SO）乳剂与肠衰竭相关肝病（IFALD）有关；鱼油（FO）乳剂用于治疗 IFALD。SO 和 FO 在脂肪酸和植物固醇含量方面存在差异。在将 SO 替换为 FO 的 IFALD 患儿中，我们旨在（1）量化红细胞脂肪酸和血浆植物固醇、细胞因子和胆汁酸的变化，（2）将这些变化与直接胆红素（DB）相关联。
设计
这项研究纳入了接受 FO 治疗 6 个月的 IFALD 患儿。在 FO 之前、FO 后 2 周、3 个月和 6 个月采集血样。主要结局是 3 个月与基线时的生物标志物浓度相比。
结果
在研究开始时，中位患者年龄为 3 个月（四分位距，3-17 个月），平均±标准差 DB 为 5.6±0.7mg/dL（n=14）。79%的患者出现胆汁淤积逆转。二十碳五烯酸和二十二碳六烯酸高于基线（所有时间点 P<0.001）。亚油酸和花生四烯酸以及谷甾醇和豆甾醇低于基线（所有时间点 P<0.05）。3 个月和 6 个月时白细胞介素-8（IL-8）以及总胆汁酸和结合胆汁酸均低于基线（P<0.05）。基线 IL-8 与基线 DB 相关（r=0.71，P<0.01）。早期 stigmasterol 和 IL-8 的变化与随后的 DB 变化相关（r=0.68 和 0.75，P<0.05）。
结论
特定的脂肪乳剂成分可能在 IFALD 中起作用。豆甾醇和 IL-8 可能预测 FO 治疗反应。
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