Forchielli M L, Gura K M, Sandler R, Lo C
Combined Program in Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts, USA.
J Pediatr Gastroenterol Nutr. 1995 Nov;21(4):374-82.
Cholestasis often occurs in infants on total parenteral nutrition (TPN) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against cholestasis associated with total parenteral nutrition (CATPN). The development of cholestasis may also be caused by other risk factors such as prematurity, surgery, sepsis, and extracorporeal membrane oxygenation (ECMO). To evaluate the relative effectiveness of the pediatric amino acid formulations in reducing CATPN, the courses of 70 infants < 1 year of age who received TPN for at least 14 days were reviewed. Cholestasis was defined as a conjugated serum bilirubin > or = 2 mg/dl subsequent to the initiation of TPN; CATPN was considered present when other factors related to cholestasis were ruled out. Liver function tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholestasis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, while 15 (21.4%) developed cholestasis secondary to other factors. Of the 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosyn PF, and 2 had received both solutions. Aminosyn PF and Trophamine, along with other potential risk factors for CATPN such as antecedent surgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were analyzed by regression-analysis methods. None was statistically significant except the length of TPN (p = 0.0063). In conclusion, we cannot support the view that Trophamine is more effective than Aminosyn PF in the prevention of CATPN.
长期接受全胃肠外营养（TPN）的婴儿常发生胆汁淤积。专门为婴儿开发的氨基酸制剂，即小儿氨基酸注射液（Aminosyn PF）和小儿营养注射液（Trophamine），可能预防与全胃肠外营养相关的胆汁淤积（CATPN）。胆汁淤积的发生也可能由其他风险因素引起，如早产、手术、败血症和体外膜肺氧合（ECMO）。为评估小儿氨基酸制剂在降低CATPN方面的相对有效性，回顾了70例年龄小于1岁且接受TPN至少14天的婴儿的病程。胆汁淤积定义为TPN开始后血清结合胆红素≥2mg/dl；当排除与胆汁淤积相关的其他因素时，则认为存在CATPN。在开始TPN前24小时以及TPN输注期间的第7、15和21天记录肝功能测试结果。30例婴儿（42.8%）发生了胆汁淤积。70例婴儿中有15例（21.4%）被判定发生了CATPN，而15例（21.4%）因其他因素继发胆汁淤积。在15例CATPN患者中，7例接受了小儿营养注射液，6例接受了小儿氨基酸注射液，2例同时接受了这两种溶液。采用回归分析方法分析了小儿氨基酸注射液和小儿营养注射液以及CATPN的其他潜在风险因素，如既往手术、败血症、ECMO、早产以及氮/热量摄入。除TPN时长外（p = 0.0063），其他因素均无统计学意义。总之，我们不能支持小儿营养注射液在预防CATPN方面比小儿氨基酸注射液更有效的观点。
