Total parenteral nutrition therapy and liver injury: a histopathologic study with clinical correlation
Total parenteral nutrition therapy and liver injury: a histopathologic study with clinical correlation
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DOI：
10.1016/j.humpath.2011.07.008
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发表时间：
2012-06-01
期刊：
影响因子：
3.3
通讯作者：
Lassman, Charles R.
中科院分区：
文献类型：
--
作者：
Naini, Bita V.;Lassman, Charles R.
全肠外营养（TPN）治疗是公认的肝损伤原因。文献中归因于 TPN 的组织学变化差异很大。在这项研究中，我们描述了与 TPN 治疗相关的组织病理学变化，并将这些变化与各种临床参数联系起来。我们对 89 名在 TPN 期间接受活检或肝移植的患者进行了回顾性研究。我们报告称，(1) 导管减少症（以前未报告的发现）在接受 TPN 的大量患者中出现。它更常见于低纤维化阶段的患者，并且可能与治疗时间成反比关系； (2)静脉周围纤维化是高级门静脉纤维化患者的常见特征。事实上，我们发现门静脉纤维化和静脉周围纤维化的结合是 TPN 损伤的一个特征； (3)婴儿更容易发生TPN相关的肝细胞损伤，更容易发生纤维化，并且比年龄较大的儿童和成人更快地进展为高级纤维化； (4)胆汁淤积虽然在婴儿中更为常见，但在所有年龄组中都是最常见的病理表现； (5)脂肪变性在年龄较大的儿童和成人中比婴儿更常见； (6) 婴儿纤维化的进展可能取决于治疗时间的长短和 TPN 治疗的基础疾病； (7) 肝损伤的临床标志物（例如，肝酶升高）不能预测肝细胞损伤或纤维化的程度，因此，接受 TPN 治疗的患者可能需要进行连续活检。(c) 2012 Elsevier Inc. 保留所有权利。 (c) 2012 Elsevier Inc. 保留所有权利。
Total parenteral nutrition (TPN) therapy is a well-recognized cause of liver injury. The histologic changes attributed to TPN in the literature vary widely. In this study, we describe the histopathologic changes associated with TPN therapy and relate these changes to various clinical parameters. We conducted a retrospective study of 89 patients who underwent biopsy or liver transplantation while on TPN. We report that (1) ductopenia, a previously unreported finding, is seen in a significant number of patients on TPN. It is more frequently seen in patients with low stage of fibrosis and may have an inverse relationship with the length of therapy; (2) Perivenular fibrosis is a feature frequently seen in patients with high-stage portal fibrosis. In fact, we find the combination of portal and perivenular fibrosis to be a characteristic of TPN injury; (3) Infants are more susceptible to TPN related hepatocellular injury, are more likely to develop fibrosis, and progress to high-stage fibrosis more rapidly than older children and adults; (4) Cholestasis, although more common in infants, is the most common pathologic finding in all age groups; (5) Steatosis is more commonly seen in older children and adults than in infants; (6) Progression to fibrosis in infants may be dependent on the length of therapy and the underlying disease for which TPN is administered; and (7) Clinical markers of liver injury (eg, elevated liver enzymes) do not predict the degree of hepatocellular injury or fibrosis, and therefore, serial biopsies may be indicated for patients on TPN therapy.(c) 2012 Elsevier Inc. All rights reserved. (c) 2012 Elsevier Inc. All rights reserved.