鱼油脂肪乳剂和中长链脂肪乳剂对肠衰竭相关肝损害患儿肝功能的影响研究

Effects of a fish oil lipid emulsion versus a MCT/LCT lipid emulsion on intestinal failure associated liver disease in children

目的比较鱼油脂肪乳剂和中长链脂肪乳剂对肠衰竭相关肝损害患儿肝功能的影响。方法回顾性分析上海交通大学医学院附属新华医院1999年1月至2017年5月65例接受肠外营养肠衰竭患儿的临床资料。患儿最初均采用中长链脂肪乳剂(按患儿体重计算,平均剂量1.2g/kg)进行治疗,此时肝功能各项指标正常,当TBA、ALT、AST、AKP、γ-GT、Tbi、Dbi中任何3项高于正常参考值范围2倍水平时进行干预方案调整,本组中有31例更换为鱼油脂肪乳剂(按患儿体重计算,平均剂量1g/kg)治疗,余34例继续应用中长链脂肪乳剂治疗。治疗过程中每周监测一次肝功能。结果鱼油脂肪乳剂组ALT、γ-GT、Tbi水平均显著下降(P<0.05),而中长链脂肪乳剂组仅AST、Tbi水平出现下降(P<0.05)。两组对比结果显示,干预前鱼油脂肪乳剂组ALT、Dbi水平显著高于中长链脂肪乳剂组(P<0.05),干预后两组肝功能指标均无显著差异(P>0.05)。鱼油脂肪乳剂组肝功能恢复正常时间的中位数为22(17~32)d,中长链脂肪乳剂组肝功能恢复正常时间的中位数为28(15~52.5)d,两者比较差异具有统计学意义(P<0.05)。结论相比于中长链脂肪乳剂,鱼油脂肪乳剂更有助于减轻小儿肠衰竭相关肝损害程度。

Objective To compare the effects of fish oil(FO)lipids with medium-long chain(MCT/LCT)lipids on intestinal failure associated liver disease(IFALD)in children. Methods We enrolled 65 children with intestinal failure for long-term parenteral nutrition(PN)from Xinhua Hospital from January 1999 through May 2017.All children initially received MCT/LCT lipids(based on body weight with an average daily dose of 1.2 g/kg).Liver function was normal at that time.The levels of any three of measurements of total bile acid(TBA),alanine transaminase(ALT),aspartate transaminase(AST),alkaline phosphatase(AKP),gamma glutamyl transferase(γ-GT),total bilirubin(Tbi)or direct bilirubin(Dbi)were two folds higher than normal levels during PN.Thirty-one patients were switched lipids into FO lipids(based on body weight with an average daily dose of 1g/kg)and 34 patients continued MCT/LCT lipids.And liver function was monitored weekly during treatment. Results ALT,γ-GT and Tbi markedly decreased in FO group( P <0.05).In MCT/LCT group,only the serum levels of AST and Tbi declined( P <0.05).Comparison results of two groups: Before treatment,ALT and Dbi markedly increased in FO group( P <0.05),but the liver function was no significant differance after treatment( P >0.05). The median time to reversal of liver dysfunction was 22(17-32)days in FO group and 28(15-52.5)days in MCT/LCT group( P <0.05). Conclusion Fish oil lipids may alleviate IFALD in children.