Parenteral nutrition associated liver disease.
Parenteral nutrition associated liver disease.
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DOI：
10.1016/s1084-2756(03)00094-0
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发表时间：
2003-10-01
期刊：
影响因子：
--
通讯作者：
Fishbein, Thomas M
中科院分区：
文献类型：
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作者：
Kaufman, Stuart S;Gondolesi, Gabriel E;Fishbein, Thomas M
肝病在肠外营养（PN）期间相对常见。胆汁淤积在婴儿中占主导地位，其严重程度从血浆结合胆红素轻度升高到导致患者死亡的进行性肝功能衰竭不等。肝病的严重程度主要取决于表明 PN 的潜在肠道问题的严重程度。非肠道疾病引起的短暂性肠梗阻通常会导致轻微的自限性肝损伤。由于坏死性小肠结肠炎或先天性畸形而切除大段肠道预示着病程更长，预后谨慎，特别是在最初并发败血症时。 PN 相关肝病的发病机制尚不完全清楚。目前还没有经过证实的治疗方法可以通过残余肠或肠移植（无论是否同时进行肝移植）来结束 PN。需要比移植更温和的有效干预措施。包括对 PN 相关肝病新疗法进行前瞻性试验的研究是改善预后的关键。
Liver disease is relatively common during parenteral nutrition (PN). Cholestasis predominates in infants, and ranges in severity from mild increases in plasma conjugated bilirubin to progressive liver failure that results in death of the patient. Severity of liver disease depends primarily on the magnitude of the underlying intestinal problem that indicated PN. Transient ileus resulting from a non-intestinal disorder usually results in trivial, self-limited liver injury. Removal of a large segment of the intestinal tract because of necrotizing enterocolitis or a congenital malformation predicts a more prolonged course with a guarded prognosis, particularly when initially complicated by sepsis. Pathogenesis of PN-associated liver disease is not completely understood. There is no proven treatment short of ending PN through adaptation of remnant intestine or intestinal transplantation, with or without a concurrent liver graft. Effective interventions that are less radical than transplantation are needed. Research that includes prospective trials of novel therapies in PN-associated liver disease is the key to improving outcome.