长期肠外营养的肠衰竭患者的肝功能评估。
Advanced liver function assessment in patients with intestinal failure on long-term parenteral nutrition.
机构信息
Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Rhine-Westphalia Institute of Technology, Pauwelsstraße 30, 52074 Aachen, Germany.
出版信息
Clin Nutr. 2020 Feb;39(2):540-547. doi: 10.1016/j.clnu.2019.02.039. Epub 2019 Mar 5.
BACKGROUND & AIMS: Intestinal failure associated liver disease (IFALD) is one of the leading complications and causes of deaths in adult patients receiving home parenteral nutrition for chronic intestinal failure (CIF). Early diagnosis of IFALD is key to alleviate the progression of hepatic dysfunction. The aim of this study was to evaluate the capability of noninvasive liver function tests.
METHODS
90 adult patients with CIF receiving long-term home parenteral nutrition were included in a prospective cross-sectional study at our department between 2014 and 2017. All participants underwent dynamic liver function assessment (maximum liver function capacity [LiMAx] test, indocyanine green [ICG] test), transient elastography (FibroScan), blood tests and comprehensive nutritional status assessment. Univariate and multivariable analysis were performed to identify predictors of liver function.
RESULTS
LiMAx, ICG test, and FibroScan highly correlated with standard liver function tests. Multivariable analysis identified intact ileum (B = 520.895; p = 0.010), digestive anatomy type 3 (B = 75.612; p = 0.025), citrulline level (B = 3.428; p = 0.040), parenteral olive oil intake (B = -0.570; p = 0.043), and oral intake (B = 182.227; p = 0.040) as independent risk factors affecting liver function determined by LiMAx test. ICG test and FibroScan showed no correlation with gastrointestinal and nutrition-related parameters.
CONCLUSION
The LiMAx test is significantly associated with widely accepted risk factors for IFALD by multivariable analysis, whereas ICG test and FibroScan failed to show significant correlations. Liver function assessment by LiMAx test may therefore have the potential to detect alterations in liver function and identify patients at risk for the development of IFALD. Longitudinal studies are needed to investigate the impact of liver function determined by LiMAx test on long-term outcome in patients with CIF.
背景与目的
肠衰竭相关肝病（IFALD）是接受慢性肠衰竭（CIF）家庭肠外营养治疗的成年患者的主要并发症和死亡原因之一。IFALD 的早期诊断是缓解肝功能障碍进展的关键。本研究旨在评估非侵入性肝功能检测的能力。
方法
2014 年至 2017 年，我们科室对 90 名接受长期家庭肠外营养治疗的 CIF 成年患者进行了一项前瞻性横断面研究。所有参与者均接受了动态肝功能评估（最大肝功能容量[LiMAx]测试、吲哚菁绿[ICG]测试）、瞬时弹性成像（FibroScan）、血液检查和综合营养状况评估。进行单变量和多变量分析以确定肝功能的预测因素。
结果
LiMAx、ICG 测试和 FibroScan 与标准肝功能测试高度相关。多变量分析确定完整的回肠（B=520.895；p=0.010）、消化解剖类型 3（B=75.612；p=0.025）、瓜氨酸水平（B=3.428；p=0.040）、静脉注射橄榄油摄入（B=-0.570；p=0.043）和口服摄入（B=182.227；p=0.040）是影响 LiMAx 测试肝功能的独立危险因素。ICG 测试和 FibroScan 与胃肠道和营养相关参数没有相关性。
结论
LiMAx 测试通过多变量分析与广泛接受的 IFALD 风险因素显著相关，而 ICG 测试和 FibroScan 未能显示出显著相关性。因此，LiMAx 测试的肝功能评估可能具有检测肝功能变化和识别发生 IFALD 风险患者的潜力。需要进行纵向研究，以调查 CIF 患者 LiMAx 测试确定的肝功能对长期结果的影响。
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