熊去氧胆酸和SMOFlipid用于治疗婴儿肠外营养相关性胆汁淤积症

Ursodeoxycholic Acid and SMOFlipid for Treating Parenteral Nutrition Associated Cholestasis in Infants.

作者信息

Al-Alaiyan Saleh, Elsaidawi Weam, Alanazi Amal M, Qeretli Raef A, Abdulaziz Najlaa A, Alfattani Areej

机构信息

Pediatrics/Neonatal-Perinatal Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, SAU.

Pediatrics, Alfaisal University, Riyadh, SAU.

出版信息

Cureus. 2022 Feb 9;14(2):e22060. doi: 10.7759/cureus.22060. eCollection 2022 Feb.

DOI:10.7759/cureus.22060

PMID:35295369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8916914/

Abstract

BACKGROUND

Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. The pathogenesis of PNAC is believed to be multifactorial; however, phytosterols are hepatotoxic, resulting in cholestasis. A novel lipid emulsion consisting of a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) with a low level of phytosterols has been shown to improve cholestasis. Moreover, ursodeoxycholic acid (UDCA) has improved bile flow and normalized liver function tests. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants.

METHODS

We conducted a retrospective cohort study that included all infants who received TPN for at least five days between January 2010 and December 2018, who also received UDCA for the treatment of cholestasis, and infants who developed cholestasis but were not treated with UDCA. In addition, any infants who received SMOFlipid for parenteral nutrition during the same period were included. We recorded multiple variables, including neonatal demographic data, major medical diagnosis, liver function, medications, and maternal variables.

RESULTS

A total of 58 infants with cholestasis who received UDCA for treatment were identified. The infants were divided into two groups, Group 1 infants had gestational age (GA) of ≤32 weeks, and Group 2 had GA of >32 weeks. We found that combining SMOFlipid with UDCA resulted in a significant reduction in cholestasis duration in both groups. Infants in Group 1 who received SMOFlipid had cholestasis for a mean of 67 ± 57 days, and those who did not receive SMOFlipid had cholestasis for a mean of 145 ± 102 days (p=0.04). Infants in Group 2 who received SMOFlipid had cholestasis for a mean of 38.2 ± 28 days, and those who did not receive SMOFlipid had cholestasis for a mean of 117 ± 119 days (p=0.02).

CONCLUSIONS

According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants.

摘要

背景

肠外营养相关胆汁淤积（PNAC）在长期接受全肠外营养（TPN）的早产儿中很常见。PNAC的发病机制被认为是多因素的；然而，植物甾醇具有肝毒性，会导致胆汁淤积。一种由大豆油、中链甘油三酯、橄榄油和鱼油（SMOFlipid）混合而成且植物甾醇含量低的新型脂质乳剂已被证明可改善胆汁淤积。此外，熊去氧胆酸（UDCA）可改善胆汁流动并使肝功能检查结果正常化。本研究旨在确定UDCA和SMOFlipid对预防和治疗婴儿PNAC的效果。

方法

我们进行了一项回顾性队列研究，纳入了2010年1月至2018年12月期间所有接受TPN至少五天、同时接受UDCA治疗胆汁淤积的婴儿，以及发生胆汁淤积但未接受UDCA治疗的婴儿。此外，还纳入了同期接受SMOFlipid进行肠外营养的任何婴儿。我们记录了多个变量，包括新生儿人口统计学数据、主要医学诊断、肝功能、用药情况和母亲变量。

结果

共确定了58例接受UDCA治疗的胆汁淤积婴儿。这些婴儿被分为两组，第1组婴儿的胎龄（GA）≤32周，第2组婴儿的胎龄>32周。我们发现，将SMOFlipid与UDCA联合使用可使两组的胆汁淤积持续时间显著缩短。第1组中接受SMOFlipid的婴儿胆汁淤积的平均时间为67±57天，未接受SMOFlipid的婴儿胆汁淤积的平均时间为145±IO2天（p = 0.04）。第2组中接受SMOFlipid的婴儿胆汁淤积的平均时间为38.2±28天，未接受SMOFlipid的婴儿胆汁淤积的平均时间为117±119天（p = 0.02）。