肠外营养相关性肝损伤机制及防治

Mechanism and prevention of parenteral nutrition-associated liver injury

肠外营养相关性肝损伤(PNALD)是持续肠外营养(PN)相关的严重代谢性并发症,也是常见并发症。其病理生理改变主要表现为胆汁淤积和肝脂肪浸润,临床上表现为肝酶异常、胆汁淤积和黄疸,严重者可导致肝功能发生不可逆的损害,甚至可引起肝衰竭及死亡,目前尚无早期识别方法。PNALD的相关机制尚不清楚,目前认为包括胆汁淤积、肠外营养制剂、肠道相关性感染。对于除外其他引起肝损的常见病因且有PN输注史的病人,可考虑诊断PNALD。PNALD的治疗原则是尽早恢复肠内营养,同时加用保肝药物。

Parenteral nutrition-associated liver disease(PNALD) is a serious metabolic complication associated with continuous parenteral nutrition(PN) and a common complication.Its pathophysiological changes are mainly manifested as cholestasis and hepatic fat infiltration,and clinically manifested as liver enzyme abnormalities,cholestasis,and jaundice,which can lead to irreversible damage of liver function and even liver failure and death in severe cases,and there is no early identification method.The mechanisms associated with PNALD are unknown and are currently thought to include cholestasis,the composition of parenteral nutrition,and gut-associated infections.The diagnosis of PNALD can be considered when other common causes of liver damage are excluded and there is a history of PN infusion.The principle of treatment for PNALD is to resume enteral nutrition as early as possible with the addition of hepatoprotective drugs.