Manganese toxicity in children receiving long-term parenteral nutrition
Manganese toxicity in children receiving long-term parenteral nutrition
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DOI：
10.1016/s0140-6736(96)90735-7
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发表时间：
1996-05-04
期刊：
影响因子：
168.9
通讯作者：
Milla, PJ
中科院分区：
文献类型：
--
作者：
Fell, JME;Reynolds, AP;Milla, PJ
背景：在接受长期肠外营养(PN)的患者中，胆汁淤积症、酸性神经系统疾病与高血锰浓度有关。在这些患者中，肝脏和肠道的正常稳态机制被绕过，对这种微量元素的需求尚不清楚；也不确定高锰酸血症是否会导致胆汁淤积，反之亦然。我们通过对接受长期肠外营养的儿童停用锰补充剂后的一系列肝功能检测，探索其影响的方向。我们还研究了临床检查和磁共振成像(MRI)显示的血锰浓度与脑部病变的关系。方法在57例接受PN的儿童中，我们确定了11例合并高锰酸血症和胆汁淤积，1例还伴有运动障碍。锰补充剂在前三个月减少，其余的停用。其中两名儿童接受了核磁共振检查。我们还观察了6名接受胃肠外营养超过2年而没有发生肝病的儿童的锰浓度和核磁共振扫描。在高锰酸血症/胆汁淤积组中，11名患者中有4名死亡。7名幸存者基线全血锰为615-1840nmol/L，4个月后下降，中位数为643nmol/L(P
Background In patients receiving long-term parenteral nutrition (PN), cholestatic disease acid nervous system disorders have been associated with high blood concentrations of manganese. In such patients, the normal homoeostatic mechanisms of the liver and gut ate bypassed and the requirement for this trace element is not known; nor has it been certain whether hypermanganesaemia causes the cholestasis or vice versa. We explored the direction of effect by serial tests of liver function after withdrawal of manganese supplements from children receiving long-term PN. We also examined the relation between blood manganese concentrations and brain lesions, as indicated by clinical examination and magnetic resonance imaging (MRI).Methods From a combined group of 57 children receiving PN we identified 11 with the combination of hypermanganesaemia and cholestasis; one also had a movement disorder. Manganese supplements were reduced in the first three and withdrawn in the remainder. MRI was done in two of these children. We also looked at manganese concentrations and MRI scans in six children who had received PN for more than 2 years without developing liver disease.Findings In the hypermanganesaemia/cholestasis group, four of the 11 patients died. In the seven survivors baseline whole-blood manganese was 615-1840 nmol/L, and after 4 months it had declined by a median of 643 nmol/L (p