Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury.
Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury.
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DOI：
10.1097/sla.0b013e3181b36657
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发表时间：
2009-09
影响因子：
9
通讯作者：
Gura KM
中科院分区：
文献类型：
--
作者：
Puder M;Valim C;Meisel JA;Le HD;de Meijer VE;Robinson EM;Zhou J;Duggan C;Gura KM
目的是确定鱼油静脉注射脂肪乳剂（IFE）治疗PNALD的安全性和有效性。肠外营养相关性肝病（PNALD）可能是短肠综合征（SBS）患儿的致命并发症。基于大豆油的IFE与肠外营养（PN）联合给药可能导致其病因。我们对42名患有SBS的婴儿进行了一项鱼油IFE的开放性试验，这些婴儿在接受大豆IFE时发生了胆汁淤积（血清直接胆红素> 2 mg/dL）。将安全性和有效性结局与同期49例SBS和胆汁淤积婴儿的结局进行比较，这些婴儿的PN疗程仅包括大豆IFE。主要疗效终点为至胆汁淤积逆转的时间（直接胆红素≤2 mg/dL）。鱼油组发生3例死亡和1例肝移植，对照组发生12例死亡和6例移植（P=0.005）。在PN期间未移植的存活者中，鱼油队列中19/38例患者的胆汁淤积在接受PN时逆转，而对照组中2/36例患者的胆汁淤积逆转。根据考克斯模型，接受鱼油IFE的受试者胆汁淤积逆转的速度比接受大豆IFE的受试者快6倍（95% CI= 2.0，37.3）。鱼油IFE的提供与高血脂、凝血功能障碍、必需脂肪酸缺乏症无关。此外，高胆红素血症事件和异常INR水平在对照组中更常见。鱼油IFE是安全的，可以有效治疗PNALD，并可以降低SBS儿童的死亡率和器官移植率。
The objective was to determine the safety and efficacy of a fish oil-based intravenous lipid emulsion (IFE) in the treatment of PNALD. Parenteral nutrition-associated liver disease (PNALD) can be a lethal complication in children with short bowel syndrome (SBS). IFE based on soybean oil administered with parenteral nutrition (PN) may contribute to its etiology. We performed an open-labeled trial of a fish-oil IFE in 42 infants with SBS who developed cholestasis (serum direct bilirubin > 2 mg/dL) while receiving soybean IFE. Safety and efficacy outcomes were compared with those from a contemporary cohort of 49 infants with SBS and cholestasis whose PN course included soybean IFE only. The primary efficacy end-point was time to reversal of cholestasis (direct bilirubin ≤2 mg/dL). Three deaths and 1 liver transplantation occurred in the fish oil cohort, compared to 12 deaths and 6 transplants in the controls (P=0.005). Among survivors not transplanted during PN, cholestasis reversed while receiving PN in 19/38 patients in the fish oil cohort vs. 2/36 patients in the controls. Based on Cox models, subjects receiving fish oil-IFE experienced reversal of cholestasis 6 times faster (95% CI=2.0,37.3) than those receiving soybean IFE. The provision of fish oil IFE was not associated with hypertriglyceridemia, coagulopathy, essential fatty acid deficiency. Moreover, hypertriglyceridemic events and abnormal INR levels were more common among controls. Fish oil IFE is safe, may be effective in treating PNALD, and may reduce mortality and organ transplantation rates in children with SBS.