Teitelbaum D H, Han-Markey T, Drongowski R A, Coran A G, Bayar B, Geiger J D, Uitvlugt N, Schork M A
Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
JPEN J Parenter Enteral Nutr. 1997 Mar-Apr;21(2):100-3. doi: 10.1177/0148607197021002100.
Neonates are at high risk for the development of parenteral nutrition-associated cholestasis when receiving a prolonged course of total parenteral nutrition (TPN). Although this cholestasis is of unknown etiology, it may result from a lack of gastrointestinal hormone formation, including cholecystokinin, which normally occurs after enteral feedings.
Two groups of neonates were studied. The treatment group consisted of 21 consecutive, prospectively enlisted neonates receiving TPN for > 14 days. The nontreatment group consisted of 21 infants from the 2 years preceding the study who were matched to the treatment group by gestational age, diagnosis, and duration of TPN. The major outcome determinant was direct bilirubin. Cholestasis was defined as a direct bilirubin > 2.0 mg/dL and was considered severe if the direct bilirubin was > 5.0 mg/dL after other causes were ruled out.
The mean direct bilirubin levels in the nontreated group progressively rose over time, whereas the mean direct bilirubin the treated group remained level. The incidence of infants with a direct bilirubin > 2.0 mg/dL was 24% and 43% in the CCK+ and CCK- groups, respectively, and was not significant (p = .14). The percentage of infants with a direct bilirubin > 5.0 mg/dL was 9.5% and 38% in the treatment and nontreatment groups, respectively, and was significant, p = .015.
Levels of direct bilirubin were lower in the treated compared with the nontreated group. These findings suggest that cholecystokinin prophylaxis in high-risk neonates may help prevent the development of parenteral nutrition-associated cholestasis.
新生儿在接受长时间的全胃肠外营养（TPN）时，发生肠外营养相关胆汁淤积的风险很高。尽管这种胆汁淤积的病因不明，但可能是由于缺乏包括胆囊收缩素在内的胃肠激素形成所致，而胃肠激素通常在肠内喂养后产生。
对两组新生儿进行了研究。治疗组由21例连续入选的、接受TPN超过14天的新生儿组成。非治疗组由研究前两年的21例婴儿组成，这些婴儿在胎龄、诊断和TPN持续时间方面与治疗组相匹配。主要结局决定因素是直接胆红素。胆汁淤积定义为直接胆红素>2.0mg/dL，如果在排除其他原因后直接胆红素>5.0mg/dL，则认为是严重胆汁淤积。
未治疗组的平均直接胆红素水平随时间逐渐升高，而治疗组的平均直接胆红素水平保持稳定。直接胆红素>2.0mg/dL的婴儿在CCK+组和CCK-组中的发生率分别为24%和43%，差异无统计学意义（p=0.14）。直接胆红素>5.0mg/dL的婴儿在治疗组和非治疗组中的百分比分别为9.5%和38%，差异有统计学意义，p=0.015。
与未治疗组相比，治疗组的直接胆红素水平较低。这些发现表明，对高危新生儿进行胆囊收缩素预防可能有助于预防肠外营养相关胆汁淤积的发生。
