Dahlström K A, Goulet O J, Roberts R L, Ricour C, Ament M E
Department of Pediatrics, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
J Pediatr. 1988 Dec;113(6):985-90. doi: 10.1016/s0022-3476(88)80568-7.
The effect of intravenously administered lipids (intralipid) on immunologic function, complement, and coagulation was prospectively studied over 1 year in 15 children. The mean age of the children was 52.4 +/- 37.9 months; they had received total parenteral nutrition for an average of 3 years. Immunoglobulins (IgA, IgM, IgG), coagulation studies (platelets, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrinogen degradation products, factor V) and components of complement (C3, C4, and CH100) were analyzed. Activation of monocytes by opsonized zymosan was measured by chemiluminescence and compared with that of normal control subjects. The clinically stable children had normal monocyte activation and normal complement levels. The PT and PTT values were significantly increased but improved with increased intralipid dose; other coagulation factors were normal. Acutely sick children, however, had decreased fat tolerance with significantly increased serum triglyceride levels and PT and PTT values; their monocyte activation and complement factors remained normal. These data indicate that the dose of intralipid should be lowered during acute illnesses; we suggest close monitoring of PT and PTT values and of serum triglyceride and cholesterol levels to avoid the fat overload syndrome.
在15名儿童中对静脉输注脂质（英脱利匹特）对免疫功能、补体和凝血的影响进行了为期1年的前瞻性研究。儿童的平均年龄为52.4±37.9个月；他们平均接受了3年的全胃肠外营养。分析了免疫球蛋白（IgA、IgM、IgG）、凝血研究指标（血小板、凝血酶原时间（PT）、部分凝血活酶时间（PTT）、纤维蛋白原、纤维蛋白原降解产物、因子V）和补体成分（C3、C4和CH100）。通过化学发光法测定调理酵母聚糖对单核细胞的激活作用，并与正常对照受试者进行比较。临床稳定的儿童单核细胞激活正常，补体水平正常。PT和PTT值显著升高，但随着英脱利匹特剂量增加而改善；其他凝血因子正常。然而，急性病患儿脂肪耐受性降低，血清甘油三酯水平以及PT和PTT值显著升高；他们的单核细胞激活和补体因子仍保持正常。这些数据表明，在急性疾病期间应降低英脱利匹特的剂量；我们建议密切监测PT和PTT值以及血清甘油三酯和胆固醇水平，以避免脂肪超载综合征。
