Chou Y H, Yau K I, Hsu H C, Chang M H
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1993 Jul-Aug;34(4):264-71.
To evaluate total parenteral nutrition-associated cholestasis (TPN-C) in infants, a retrospective clinicopathologic study was conducted of 15 infants who had received TPN. The mean gestational age and birth weight were 32.1 weeks (26-40 weeks) and 1807 g (840-5840 g) respectively. Two-thirds of the patients were kept on TPN for more than 60 days. The onset of rising direct bilirubin ranged 2-9 weeks (mean 4.5 +/- 2.4) after TPN therapy. Preterm babies less than 32 weeks of age had an earlier rise of direct bilirubin and AST. Bile sludge of the gallbladder was observed in only one case, and none had gallstone. The main histologic findings of liver biopsy or autopsy were cholestasis (intracellular and canalicular), periportal inflammation, fibrosis and bile ductular proliferation. Sixty percent of these survived, the remaining 40% died of complications unrelated to TPN-C. The liver function profile became normalized within a mean of 14.0 +/- 9.4 (8-34) weeks after discontinuation of TPN in the survival cases. It was concluded that infant TPN-associated cholestasis was mostly reversible, but that the younger preterm babies were susceptible to a prolonged TPN course with more marked clinical and pathological changes.
为评估婴儿全胃肠外营养相关胆汁淤积症（TPN-C），对15例接受TPN的婴儿进行了一项回顾性临床病理研究。平均胎龄和出生体重分别为32.1周（26 - 40周）和1807克（840 - 5840克）。三分之二的患者接受TPN治疗超过60天。直接胆红素升高的起始时间在TPN治疗后2 - 9周（平均4.5 +/- 2.4周）。小于32周的早产儿直接胆红素和AST升高更早。仅1例观察到胆囊胆汁淤积，无1例有胆结石。肝活检或尸检的主要组织学发现为胆汁淤积（细胞内和胆小管）、汇管区炎症、纤维化和胆小管增生。其中60%存活，其余40%死于与TPN-C无关的并发症。存活病例在停用TPN后平均14.0 +/- 9.4（8 - 34）周内肝功能恢复正常。结论是婴儿TPN相关胆汁淤积症大多可逆，但较小的早产儿易出现较长时间的TPN病程，伴有更明显的临床和病理变化。
