早产儿肠外营养相关性胆汁淤积症的危险因素分析及治疗
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摘要
早产儿在接受胃肠外营养治疗时易发生胆汁淤积,在极低出生体重儿中其发生率可达18%～24%,甚至可进一步发展为胆汁淤积性肝硬化和肝功能衰竭。近年来,国内外学者在早产儿发生胆汁淤积的危险因素分析及治疗方面取得了一些进展,发现引起胆汁淤积的主要原因是早产、缺乏肠道喂养、长期使用肠外营养(PN)、感染和肠损伤、药物等。有效治疗胆汁淤积的药物主要为熊去氧胆酸、S-腺苷蛋氨酸(SAMe)、红霉素等,且安全性较高。
Premature infants are prone to cholestasis when receiving parenteral nutrition. In very low birth weight infants, the incidence can reach 18% to 24%, and even further progress to cholestatic cirrhosis and liver failure. In recent years, domestic and foreign scholars have made important progress in the analysis and treatment of risk factors for cholestasis in premature infants. The main causes of cholestasis were premature birth, low birth weight, lack of intestinal feeding, long-term use of parenteral nutrition(PN),repeated sepsis and intestinal damage, drugs, etc. The drugs that can effectively treat cholestasis are mainly ursodeoxycholic acid,S-adenosylmethionine(SAMe), erythromycin, etc., and have high safety.
Premature infants are prone to cholestasis when receiving parenteral nutrition. In very low birth weight infants, the incidence can reach 18% to 24%, and even further progress to cholestatic cirrhosis and liver failure. In recent years, domestic and foreign scholars have made important progress in the analysis and treatment of risk factors for cholestasis in premature infants. The main causes of cholestasis were premature birth, low birth weight, lack of intestinal feeding, long-term use of parenteral nutrition(PN),repeated sepsis and intestinal damage, drugs, etc. The drugs that can effectively treat cholestasis are mainly ursodeoxycholic acid,S-adenosylmethionine(SAMe), erythromycin, etc., and have high safety.
引文
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[6]阳勇,钱新华,郭丽珊,等.新生儿长期胃肠外营养相关性胆汁淤积的发生率及其影响因素[J].实用儿科临床杂志,2010,25(2).
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[8]El Kasmi K C,Anderson A L,Devereaux M W,et al.Phytosterols Promote Liver Injury and Kupffer Cell Activation in Parenteral Nutrition-Associated Liver Disease[J].Science Translational Medicine,2013,5(206):206.
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[10]Sanchez S E,Braun L P,Mercer L D,et al.The effect of lipid restriction on the prevention of parenteral nutrition-associated cholestasis in surgical infants[J].Journal of Pediatric Surgery,2013,48(3):573-578.
[11]M Steinbach,R H Clark,A S Kelleher,C Flores,R White,D H Chace,AR Spitzer.Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant[J].Journal of Perinatology Official Journal of the California Perinatal Association,2008,28(2):129.
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[13]De Urbina J J O,Jorquera F,Culebras J M,et al.Effects of Parenteral Nutrition Supplemented with Alanyl-Glutamine on Nutrition Status in Rats[J].Journal of Parenteral and Enteral Nutrition,2005,29(4):262-265.
[14]Puligandla P S,Janvier A,Hélène Flageole,et al.The significance of intrauterine growth restriction is different from prematurity for the outcome of infants with gastroschisis[J].Journal of Pediatric Surgery,2004,39(8):0-1204.
[15]Hsieh MH,Pai W,Tseng HI,et al.Parenteral Nutrition-associated Cholestasis in Premature Babies:Risk Factors and Predictors[J].Pediatrics&Neonatology,2009,50(5):202-207.
[16]Hoang V,Sills J,Chandler M,et al.Percutaneously Inserted Central Catheter for Total Parenteral Nutrition in Neonates:Complications Rates Related to Upper Versus Lower Extremity Insertion[J].PEDIATRICS,2008,121(5):1152-1159.
[17]Brito C S D,Brito D V D D,Abdallah V O S,et al.Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates[J].Journal of Infection,2010,60(2):128-132.
[18]Aghai Z H,Mudduluru M,Nakhla T A,et al.Fluconazole prophylaxis in extremely low birth weight infants:association with cholestasis[J].Journal of Perinatology,2006,26(9):550-555.
[19]Chen C Y,Tsao P N,Chen H L,et al.Ursodeoxycholic acid(UDCA)therapy in very-low-birth-weight infants with parenteral nutrition-associated cholestasis[J].Journal of Pediatrics,2004,145(3):0-321.
[20]Thibault M,Mcmahon J,Faubert G,et al.Parenteral Nutrition-Associated Liver Disease:a Retrospective Study of Ursodeoxycholic Acid Use in Neonates[J].Journal of Pediatric Pharmacology&Therapeutics Jppt the Official Journal of Ppag,2014,19(1):42.
[21]Ng P C,Lee C H,Wong S P S,et al.High-Dose Oral Erythromycin Decreased the Incidence of Parenteral Nutrition-Associated Cholestasis in Preterm Infants[J].Gastroenterology,2007,132(5):1726-1739.
[22]李世芳,赵淑艳,张环,等.S-腺苷蛋氨酸对极低出生体重儿胃肠外营养相关性胆汁淤积的防治作用[J].中国实用医药,2012,07(15):30-31.
[23]刘怡晟,蔡威,吴圣楣,等.S-腺苷-L-蛋氨酸防治全胃肠外营养所致肝内胆汁郁积的实验研究[J].临床儿科杂志,2005,23(4):239-242.
[2]Alkharfy T,Ba-Abbad R,Hadi A,et al.Total parenteral nutritionassociated cholestasis and risk factors in preterm infants[J].Saudi Journal of Gastroenterology,2014,20(5):293.
[3]Ah-Young K,Ryoung-Kyoung L,Young-Mi H,et al.Parenteral NutritionAssociated Cholestasis in Very Low Birth Weight Infants:A Single Center Experience[J].Pediatric Gastroenterology,Hepatology&Nutrition,2016,19(1):61.
[4]侯林,刘捷,曾超美.早产儿肠外营养相关性胆汁淤积症的防治进展[J].中国生育健康杂志,2018,29(03):293-296.
[5]Costa S,Maggio L,Sindico P,et al.Preterm Small for Gestational Age Infants Are Not at Higher Risk for Parenteral Nutrition-Associated Cholestasis[J].J Pediatr,2010,156(4):575-579.
[6]阳勇,钱新华,郭丽珊,等.新生儿长期胃肠外营养相关性胆汁淤积的发生率及其影响因素[J].实用儿科临床杂志,2010,25(2).
[7]Zhidong Xu,Kevin A.Harvey,Thomas Pavlina,et al.Steroidal Compounds in Commercial Parenteral Lipid Emulsions[J].Nutrients,2012,4(12):904-921.
[8]El Kasmi K C,Anderson A L,Devereaux M W,et al.Phytosterols Promote Liver Injury and Kupffer Cell Activation in Parenteral Nutrition-Associated Liver Disease[J].Science Translational Medicine,2013,5(206):206.
[9]Fell G L,Cho B S,Pan A,et al.A Comparison of Fish Oil Sources for Parenteral Lipid Emulsions in a Murine Model[J].Jpen J Parenter Enteral Nutr,2016,41(2):703.
[10]Sanchez S E,Braun L P,Mercer L D,et al.The effect of lipid restriction on the prevention of parenteral nutrition-associated cholestasis in surgical infants[J].Journal of Pediatric Surgery,2013,48(3):573-578.
[11]M Steinbach,R H Clark,A S Kelleher,C Flores,R White,D H Chace,AR Spitzer.Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant[J].Journal of Perinatology Official Journal of the California Perinatal Association,2008,28(2):129.
[12]Kadrofske M M,Parimi P S,Gruca L L,et al.Effect of intravenous amino acids on glutamine and protein kinetics in low-birth-weight preterm infants during the immediate neonatal period[J].Ajp Endocrinology&Metabolism,2006,290(4):E622-30.
[13]De Urbina J J O,Jorquera F,Culebras J M,et al.Effects of Parenteral Nutrition Supplemented with Alanyl-Glutamine on Nutrition Status in Rats[J].Journal of Parenteral and Enteral Nutrition,2005,29(4):262-265.
[14]Puligandla P S,Janvier A,Hélène Flageole,et al.The significance of intrauterine growth restriction is different from prematurity for the outcome of infants with gastroschisis[J].Journal of Pediatric Surgery,2004,39(8):0-1204.
[15]Hsieh MH,Pai W,Tseng HI,et al.Parenteral Nutrition-associated Cholestasis in Premature Babies:Risk Factors and Predictors[J].Pediatrics&Neonatology,2009,50(5):202-207.
[16]Hoang V,Sills J,Chandler M,et al.Percutaneously Inserted Central Catheter for Total Parenteral Nutrition in Neonates:Complications Rates Related to Upper Versus Lower Extremity Insertion[J].PEDIATRICS,2008,121(5):1152-1159.
[17]Brito C S D,Brito D V D D,Abdallah V O S,et al.Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates[J].Journal of Infection,2010,60(2):128-132.
[18]Aghai Z H,Mudduluru M,Nakhla T A,et al.Fluconazole prophylaxis in extremely low birth weight infants:association with cholestasis[J].Journal of Perinatology,2006,26(9):550-555.
[19]Chen C Y,Tsao P N,Chen H L,et al.Ursodeoxycholic acid(UDCA)therapy in very-low-birth-weight infants with parenteral nutrition-associated cholestasis[J].Journal of Pediatrics,2004,145(3):0-321.
[20]Thibault M,Mcmahon J,Faubert G,et al.Parenteral Nutrition-Associated Liver Disease:a Retrospective Study of Ursodeoxycholic Acid Use in Neonates[J].Journal of Pediatric Pharmacology&Therapeutics Jppt the Official Journal of Ppag,2014,19(1):42.
[21]Ng P C,Lee C H,Wong S P S,et al.High-Dose Oral Erythromycin Decreased the Incidence of Parenteral Nutrition-Associated Cholestasis in Preterm Infants[J].Gastroenterology,2007,132(5):1726-1739.
[22]李世芳,赵淑艳,张环,等.S-腺苷蛋氨酸对极低出生体重儿胃肠外营养相关性胆汁淤积的防治作用[J].中国实用医药,2012,07(15):30-31.
[23]刘怡晟,蔡威,吴圣楣,等.S-腺苷-L-蛋氨酸防治全胃肠外营养所致肝内胆汁郁积的实验研究[J].临床儿科杂志,2005,23(4):239-242.