Huang Liufang,Wang Nan,Zhang Tian,et al.Effects of a fish oil lipid emulsion versus a MCT/LCT lipid emulsion on intestinal failure associated liver disease in children[J].Journal of Clinical Pediatric Surgery,,18():752-756.[doi:10.3969/j.issn.1671-6353.2019.09.009]
Effects of a fish oil lipid emulsion versus a MCT/LCT lipid emulsion on intestinal failure associated liver disease in children
- CLC:
- R729;R723.1;R446.11+2
- Abstract:
- 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.
References:
1 Pironi L,Arends J,Bozzetti F,et al.ESPEN guidelines on chronic intestinal failure in adults[J].Clin Nutr,2016,35(2):247-307.DOI:10.1016/j.clnu.2016.01.020.
2 Willis TC,Carter BA,Rogers SP,et al.High rates of mortality and morbidity occur in infants with parenteral nutrition-associated cholestasis[J].JPEN J Parenter Enteral Nutr,2010,34(1):32-37.DOI:10.1177/0148607109332772.
3 Fallon EM,Mitchell PD,Nehra D,et al.Neonates with short bowel syndrome:an optimistic future for parenteral nutrition independence[J].Jama Surg,2014,149(7):663-670.DOI:10.1001/jamasurg.2013.4332.
4 Peden VH,Witzleben CL,Skelton MA.Total parenteral nutrition[J].J Pediatr,1971,78(1):180-181.
5 Nandivada P,Fell GL,Mitchell PD,et al.Long-term fish oil lipid emulsion use in children with intestinal failure-associated liver disease[J].JPEN J Parenter Enteral Nutr,2017,41(6):930-937.DOI:10.1177/0148607116633796.
6 Fell GL,Cho BS,Pan A,et al.A Comparison of fish oil sources for parenteral lipid emulsions in a murine model[J].JPEN J Parenter Enteral Nutr,2017,41(2):181-187.DOI:10.1177/0148607116640275.
7 Bharadwaj S,Gohel T,Deen OJ,et al.Fish oil-based lipid emulsion:current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease[J].Gastroenterol Rep(Oxf),2015,3(2):110-114.DOI:10.1093/gastro/gov011.
8 Calkins KL,Debarber A,Steiner RD,et al.Intravenous fish oil and pediatric intestinal failure-associated liver disease:changes in plasma phytosterols,cytokines,and bile acids and erythrocyte fatty acids[J].JPEN J Parenter Enteral Nutr,2018,42(3):633-641.DOI:10.1177/0148607117709196.
9 Duro D,Mitchell PD,Kalish LA,et al.Risk factors for parenteral nutrition-associated liver disease following surgical therapy for necrotizing enterocolitis:A Glaser Pediatric Research Network Study[J].J Pediatr Gastroenterol Nutr,2011,52(5):595-600.DOI:10.1097/MPG.0b013e31820e8396.
10 Wang Y,Zhou K,Tang Q,et al.Effect of an olive oil-based lipid emulsion compared with a soybean oil-based lipid emulsion on liver chemistry and bile acid composition in preterm infants receiving parenteral nutrition[J].Jpen-Parenter Enter,2016,40(6):842-850.DOI:10.1177/0148607114566853.
11 Calder PC.Immunomodulation by omega-3 fatty acids[J].Prostaglandins Leukot Essent Fatty Acids,2007,77(5-6):327-335.DOI:10.1016/j.plefa.2007.10.015.
12 Miloudi K,Comte B,Rouleau T,et al.The mode of administration of total parenteral nutrition and nature of lipid content influence the generation of peroxides and aldehydes[J].Clin Nutr,2012,31(4):526-534.DOI:10.1016/j.clnu.2011.12.012.
13 Iyer KR,Spitz L,Clayton P.BAPS prize lecture:New insight into mechanisms of parenteral nutrition-associated cholestasis:role of plant sterols.British Association of Paediatric Surgeons[J].J Pediatr Surg,1998,33(1):1-6.
14 Gura KM,Duggan CP,Collier SB,et al.Reversal of parenteral nutrition-associated liver disease in two infantswith short bowel syndrome using parenteral fish oil:implications for future management[J].Pediatrics,2006,118(1):197-201.DOI:10.1542/peds.2005-2662.
15 Gura KM,Lee S,Valim C,et al.Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease[J].Pediatrics,2008,121(3):678-686.DOI:10.1542/peds.2007-2248.
16 Xu Z,Li Y,Wang J,et al.Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults[J].Clin Nutr,2012,31(2):217-223.DOI:10.1016/j.clnu.2011.10.001.
17 Zhang T,Wang N,Yan W,et al.Effect of a fish oil-based lipid emulsion on intestinal failure-associated liver disease in children[J].Eur J Clin Nutr,2018,72(10):1364-1372.DOI:10.1038/s41430-018-0096-z.
Memo
收稿日期:2019-05-04。
基金项目:国家自然科学基金项目（编号：81974066）；浦江人才计划项目（编号：17PJD026）；上海市小儿消化与营养重点实验室项目（编号：17DZ2272000）；本项目获上海交通大学医学院紧缺专业硕士研究生临床研究能力提升计划资助（编号：JQ201802）
通讯作者:王莹,Email:wangying02@xinhuamed.com.cn;蔡威,Email:caiw1978@163.com