Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L461, Portland, OR 97239-3098, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L461, Portland, OR 97239-3098, USA.
Clin Liver Dis. 2017 Nov;21(4):687-695. doi: 10.1016/j.cld.2017.06.008. Epub 2017 Aug 19.
Parenteral nutrition-associated liver disease (PNALD) spectrum ranges from liver enzyme abnormalities to steatosis to fibrosis, and, eventually, cirrhosis from total parenteral nutrition (TPN). The pathophysiology is postulated to be multifactorial. Diagnosis in adults is primarily by exclusion, eliminating other causes of chronic liver disease or cirrhosis, and other factors seen in critically ill or postoperative patients on TPN. Principal treatment is avoiding TPN. If this is not feasible, research supports fish oil-based lipid emulsions in TPN formulations to reduce risk and progression of PNALD. With liver and intestinal failure, liver and intestine transplant is an option.
肠外营养相关性肝病（PNALD）的范围从肝酶异常到脂肪变性，再到纤维化，最终由全肠外营养（TPN）导致肝硬化。其发病机制被推测为多因素的。成人的诊断主要通过排除法，排除其他慢性肝病或肝硬化的原因，以及在接受 TPN 的重症或术后患者中常见的其他因素。主要治疗方法是避免 TPN。如果这不可行，研究支持 TPN 配方中使用鱼油为基础的脂肪乳剂来降低 PNALD 的风险和进展。对于肝和肠衰竭的患者，肝和肠移植是一种选择。
