Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition
Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition
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DOI：
10.3945/ajcn.115.116285
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发表时间：
2015-12-01
影响因子：
7.1
通讯作者：
Maitre, Nathalie L.
中科院分区：
文献类型：
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作者：
Aschner, Judy L.;Anderson, Adam;Maitre, Nathalie L.
背景：锰是一种正常生长发育所必需的金属，在过量接触时具有神经毒性。标准的添加微量元素的新生儿肠外营养(PN)含锰量高，绕过了正常的胃肠道吸收控制机制，使婴儿面临锰神经毒性的风险。磁共振(MR)弛豫测量显示，基底节区短的T1松弛时间(T1R)反映了脑内锰的过度积累。目的：本研究验证了一种假说，即肠外锰暴露较多的婴儿比肠外锰暴露较低的婴儿有更高的脑锰蓄积。设计：暴露于肠外锰的婴儿参加前瞻性队列研究。被归类为高锰暴露的婴儿在前4周接受75%的营养作为PN。所有其他人都被归类为低暴露。计算每日肠外和肠内锰摄入量。采用高分辨率电感耦合等离子体质谱检测全血锰。一位蒙面评审员解释了大脑磁共振松弛测量法。线性回归模型，调整出生时的胎龄(GA)，估计松弛指数与总和肠外锰暴露的关联。结果：73名婴儿入选。58名婴儿可以获得高质量的磁共振图像，其中39名婴儿处于高锰暴露状态，19名婴儿处于低锰暴露状态。4名高暴露婴儿的血锰浓度为30 mU/L，在控制GA后，较高的肠外和总锰摄入量与苍白球和壳核的T1R降低相关(P=0.01)，但与全血锰无关(范围：3.6-56.6mUg/L)。结合胆红素升高放大了肠外锰与T1R降低之间的关系。结论：GA的短T1R可识别与通常用于营养危重婴儿的PN液相关的脑锰沉积增加的风险。
Background: Manganese, an essential metal for normal growth and development, is neurotoxic on excessive exposure. Standard trace element-supplemented neonatal parenteral nutrition (PN) has a high manganese content and bypasses normal gastrointestinal absorptive control mechanisms, which places infants at risk of manganese neurotoxicity. Magnetic resonance (MR) relaxometry demonstrating short T1 relaxation time (T1R) in the basal ganglia reflects excessive brain manganese accumulation.Objective: This study tested the hypothesis that infants with greater parenteral manganese exposure have higher brain manganese accumulation, as measured by MR imaging, than do infants with lower parenteral manganese exposure.Design: Infants exposed to parenteral manganese were enrolled in a prospective cohort study. Infants classified as having high manganese exposure received >75% of their nutrition in the preceding 4 wk as PN. All others were classified as having low exposure. Daily parenteral and enteral manganese intakes were calculated. Whole-blood manganese was measured by high-resolution inductively coupled plasma mass spectrometry. Brain MR relaxometry was interpreted by a masked reviewer. Linear regression models, adjusted for gestational age (GA) at birth, estimated the association of relaxometry indexes with total and parenteral manganese exposures.Results: Seventy-three infants were enrolled. High-quality MR images were available for 58 infants, 39 with high and 19 with low manganese exposure. Four infants with a high exposure had blood manganese concentrations >30 mu g/L. After controlling for GA, higher parenteral and total manganese intakes were associated with a lower T1R (P = 0.01) in the globus pallidus and putamen but were not associated with whole-blood manganese (range: 3.6-56.6 mu g/L). Elevated conjugated bilirubin magnified the association between parenteral manganese and decreasing T1R.Conclusion: A short T1R for GA identifies infants at risk of increased brain manganese deposition associated with PN solutions commonly used to nourish critically ill infants.