Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease
Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease
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DOI：
10.1542/peds.2007-2248
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发表时间：
2008-03-01
期刊：
影响因子：
8
通讯作者：
Puder, Mark
中科院分区：
文献类型：
--
作者：
Gura, Kathleen M.;Lee, Sang;Puder, Mark
背景。肠外营养相关的肝脏疾病可以是一个进行性和致命的实体短肠综合征的儿童。豆脂乳剂作为标准肠外营养的一部分可能有助于其病理生理。我们比较了鱼油脂肪乳剂对18例接受豆乳治疗后出现胆汁淤积（血清直接胆红素水平为bbbb2 mg/dL）的短肠综合征婴儿和21例接受豆乳治疗后出现胆汁淤积的短肠综合征婴儿的安全性和有效性。主要终点是胆汁淤积逆转的时间（连续3次测量血清直接胆红素水平为bbb20 mg/dL）。在幸存者中，在鱼油组和历史组中，胆汁淤积症逆转的中位时间分别为9.4周和44.1周。接受鱼油为基础的乳剂的受试者的胆汁淤积逆转速度比接受豆乳的受试者快4.8倍，在基线胆红素浓度、胎龄和坏死性小肠结肠炎诊断调整后的分析中快6.8倍。鱼油组共记录2例死亡和0例肝移植，历史组共记录7例死亡和2例肝移植。提供鱼油脂肪乳剂与必需脂肪酸缺乏、高甘油三酯血症、凝血功能障碍、感染或生长迟缓无关。以鱼油为基础的脂肪乳剂是安全的，可能有效治疗肠外营养相关的肝脏疾病。
BACKGROUND. Parenteral nutrition-associated liver disease can be a progressive and fatal entity in children with short-bowel syndrome. Soybean-fat emulsions provided as part of standard parenteral nutrition may contribute to its pathophysiology.METHODS. We compared safety and efficacy outcomes of a fish-oil-based fat emulsion in 18 infants with short-bowel syndrome who developed cholestasis (serum direct bilirubin level of > 2 mg/dL) while receiving soybean emulsions with those from a historical cohort of 21 infants with short-bowel syndrome who also developed cholestasis while receiving soybean emulsions. The primary end point was time to reversal of cholestasis (3 consecutive measurements of serum direct bilirubin level of > 2 mg/dL).RESULTS. Among survivors, the median time to reversal of cholestasis was 9.4 and 44.1 weeks in the fish-oil and historical cohorts, respectively. Subjects who received fish-oil-based emulsion experienced reversal of cholestasis 4.8 times faster than those who received soybean emulsions and 6.8 times faster in analysis adjusted for baseline bilirubin concentration, gestational age, and the diagnosis of necrotizing enterocolitis. A total of 2 deaths and 0 liver transplantations were recorded in the fish-oil cohort and 7 deaths and 2 transplantations in the historical cohort. The provision of fish-oil-based fat emulsion was not associated with essential fatty acid deficiency, hypertriglyceridemia, coagulopathy, infections, or growth delay.CONCLUSIONS. Parenteral fish-oil-based fat emulsions are safe and may be effective in the treatment of parenteral nutrition-associated liver disease.