Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pharmaceutical Services, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
JPEN J Parenter Enteral Nutr. 2021 Jan;45(1):204-207. doi: 10.1002/jpen.1823. Epub 2020 Mar 17.
Intestinal failure-associated liver disease (IFALD) is a serious complication of parenteral nutrition (PN). We report 2 cases of IFALD, which occurred in adult patients while on a regimen of multi-oil intravenous lipid emulsion containing fish oil.
Patients initially received PN containing 1-g/kg/d SMOFlipid 20% (SMOFlipid). When IFALD developed, lipid composition in PN was altered to include higher proportions of fish oil.
Case 1 was a 23-year-old man with short-bowel syndrome. He had been fully dependent on PN for approximately 11 months with a direct bilirubin level of 15.1 mg/dL. Doses of 0.15-g/kg/d pure fish oil and 0.3-0.6-g/kg/d SMOFlipid were administered for 56 days, and IFALD was resolved 59 days after adding fish oil. Case 2 was an 85-year-old man who received extensive small-bowel resection because of internal herniation and small-bowel necrosis. He had elevated direct bilirubin levels and was diagnosed with IFALD. Fish-oil treatment was initiated after 50 days of receiving PN. The average daily amount of fish oil given was 0.14 g/kg/d. IFALD was resolved 44 days after adding Omegaven (Fresenius Kabi Austria Gmbh, Austria).
Two patients with advanced IFALD showed reversal of cholestasis by altering the lipid content of their PN to include more fish oil.
肠衰竭相关肝病（IFALD）是肠外营养（PN）的严重并发症。我们报告了两例 IFALD 病例，这两例均发生在接受含鱼油的多油静脉用脂肪乳剂方案治疗的成年患者中。
患者最初接受含有 1 克/公斤/天 SMOFlipid 20%（SMOFlipid）的 PN。当发生 IFALD 时，PN 中的脂质组成被改变为包含更高比例的鱼油。
病例 1 是一名 23 岁的男性，患有短肠综合征。他大约 11 个月完全依赖 PN，直接胆红素水平为 15.1mg/dL。给予 0.15 克/公斤/天纯鱼油和 0.3-0.6 克/公斤/天 SMOFlipid 剂量，在添加鱼油后 59 天 IFALD 得到解决。病例 2 是一名 85 岁男性，因内疝和小肠坏死接受了广泛的小肠切除术。他的直接胆红素水平升高，被诊断为 IFALD。在接受 PN 50 天后开始进行鱼油治疗。每天给予鱼油的平均量为 0.14 克/公斤/天。在添加 Omegaven（奥地利 Fresenius Kabi Austria Gmbh）后 44 天 IFALD 得到解决。
两名晚期 IFALD 患者通过改变 PN 的脂质含量，包括更多的鱼油，使胆汁淤积得到逆转。
