ω-3多不饱和脂肪酸逆转肠外营养所致肝损害的实验室观察

Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition associated liver disease in adults

目的:从临床实验室和组织学观察ω-3多不饱和脂肪酸(ω-3PUFA)对成人肠外营养相关肝损害(PNALD)的作用。方法:选取15例长期行PN导致胆汁淤积(直接胆红素≥34μmol/L)的成人短肠综合征病人。动态观察病人应用ω-3PUFA前和治疗1个月内肝功能和血清游离脂肪酸谱的变化。同时行肝穿刺活检,观察治疗前和治疗1个月后的肝组织学改变。结果:ω-3PUFA治疗1个月后,80%(12/15)病人直接胆红素水平恢复正常,所有病人肝功能指标和血清游离脂肪酸谱均得到改善,从肝组织学上亦证实了这种效果。结论:ω-3PUFA能很好地逆转成人PNALD,并改善病人的血脂状况。

Objective： To investigate the effects of ω-3PUFA supplemented intravenous lipid emulsion（ILE） on PNALD in adults.Methods： We performed an open-labeled study of a ω-3PUFA-based ILE in 15 adults with SBS who developed cholestasis（serum direct bilirubin≥2 mg/dL） while receiving soybean oil-based ILE.Liver biopsy was performed before and one month after the initiation of ω-3PUFA to confirm the presence and improvement of cholestasis.Blood samples were collected every week for analysis of fatty acid composition and liver function.Results： 12 of the 15 patients had their direct bilirubin normalized within 4 weeks and direct bilirubin markedly decreased over time in our study.There were ameliorations of functional hepatic indexes and fatty acids pattern in all adults patients and serial liver biopsy specimens showed progressive histologic improvement.Conclusion： Parenteral ω-3PUFA based fat emulsions are safe and effective in the treatment of PNALD in adults.