Denton Christine, Price Amber, Friend Julie, Manithody Chandrashekhara, Blomenkamp Keith, Westrich Matthew, Kakarla Vindhya, Phillips William, Krebs Joseph, Abraham Munoz Salim, Osei Hector, Jain Ajay Kumar
Department of Pediatrics, Saint Louis University School of Medicine, 1465 South Grand Blvd., St. Louis, MO 63104, USA.
Department of Surgery, Saint Louis University School of Medicine, 1 N. Grand Blvd., St. Louis, MO 63103, USA.
Children (Basel). 2018 Sep 25;5(10):136. doi: 10.3390/children5100136.
For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come without a significant risk of complications. For instance, parenteral nutrition-associated liver disease (PNALD)-a well-described cholestatic liver injury-and atrophic changes in the gut have both been described in patients receiving PN. Although several mechanisms for these changes have been postulated, data have revealed that the introduction of enteral nutrition may mitigate this injury. This observation has led to the hypothesis that gut-derived signals, originating in response to the presence of luminal contents, may contribute to a decrease in damage to the liver and gut. This review seeks to present the current knowledge regarding the modulation of what is known as the "gut⁻liver axis" and the gut-derived signals which play a role in PN-associated injury.
几十年来，肠外营养（PN）一直是静脉输送营养的成功方法，并且仍然是肠道喂养不耐受或肠道功能受损患者的重要治疗手段。尽管肠外营养的益处显而易见，但其使用并非没有显著的并发症风险。例如，肠外营养相关肝病（PNALD）——一种已被充分描述的胆汁淤积性肝损伤——以及肠道萎缩性改变在接受肠外营养的患者中均有报道。尽管已经提出了这些变化的几种机制，但数据显示引入肠内营养可能减轻这种损伤。这一观察结果引发了一个假设，即源于对肠腔内容物存在的反应的肠道信号可能有助于减少对肝脏和肠道的损害。本综述旨在介绍有关所谓“肠-肝轴”调节以及在肠外营养相关损伤中起作用的肠道衍生信号的当前知识。
