脂肪乳剂对老年肿瘤患者肠外营养相关肝功能损伤影响的回顾性分析  

Effects of lipid emulsion on parenteral nutrition associated liver disease in old tumor patients： a retrospective study

作　　者：徐仁应[1] 万燕萍[1] 单成迪[1] 沈婉蓉[1] 陈之琦[1] 张晓敏[1] 陆丽萍[1] 

机构地区：[1]上海交通大学医学院附属仁济医院临床营养科,200001

出　　处：《中华临床营养杂志》2010年第1期24-28,共5页Chinese Journal of Clinical Nutrition

摘　　要：目的研究脂肪乳剂在老年肿瘤患者术后肠外营养相关肝功能损伤（PNALD）中的作用。方法回顾性分析2003年1月至2008年12月仁济医院402例老年肿瘤患者接受肠外营养后肝功能损伤的发生情况。纳入标准：年龄≥60岁；确诊为恶性肿瘤，无远处转移且接受肠外营养前肿瘤已完全切除；接受肠外营养前患者的肝肾功能正常；接受肠外营养≥7d；采用“全合一”方式配制肠外营养液，且经过中心静脉输注。排除标准：病毒性肝炎患者；接受肠外营养期间患者死亡。年龄（71．7±6．8）岁，平均接受了（10．2±5．9）（7～61）d肠外营养支持。77．4％（311／402）患者使用了脂肪乳剂，22．6％（91／402）患者输注了不含脂肪乳剂的肠外营养液。碳水化合物、脂肪和氨基酸的平均供给量分别为（1．8±0．7）、（0．9±0．4）和（0．7±0．2）g·kg^-1·d^-1平均供热量和热氮比分别为（69．8±27．2）kJ·kg^-1·d^-1和（660．4±255．4）kJ：1g氮。结果402例老年肿瘤患者PNALD的发生率为15．2％（61／402）。接受不含脂肪乳剂肠外营养支持老年患者PNALD的发生率为8．8％（8／91），而接受脂肪乳剂老年患者PNALD的发生率为17．0％（53／311），两者的差异无统计学意义（X^2=3．72，P〉0．05）。脂肪乳剂种类和用量对PNALD发生率无显著影响（P〉0，05）。Logistic回归分析显示，体温升高天数（P〈0．001）、丙氨酸氨基转移酶（P〈0．001）和γ-谷氨酰转移酶（P〈0．001）是PNALD发生的危险因素。结论给老年肿瘤患者术后应用脂肪乳剂是安全的，且对PNALD的发生未产生显著影响。Objective To evaluate the effects of lipid emulsion on parenteral nutrition associated liver disease （PNALD） in old tumor patients. Methods A retrospective study was performed with 402 patients in Renji Hospital from January 2003 to December 2008. Patients were retrieved according to the following criteria： （ 1 ） age ≥ 60 years; （2） confirmed diagnosis of tumor, had no evidence of metastasis, and tumor was completely resected before receiving parenteral nutrition ; （ 3 ） liver and kidney function was in normal range before receiving parenteral nutrition ; （4） parenteral nutrition days ≥7 ; and （5） parenteral nutrition was infused in ＂all in one＂ bag via central venous. Patients with history of viral hepatitis or died in parenteral nutrition episode were excluded. These 402 patients aged （71.7 ± 6.8 ） years and the average parenteral nutrition time was （ 10. 2 ± 5.9 ） （range, 7-61 ） days. In 311 patients （77. 4% ）, non-protein calorie was obtained from carbohydrate and lipid and 91 patients （22. 6% ） just obtained non-protein calorie from carbohydrate. Results The total prevalence of PNALD was 15.2% （61/402）. The prevalence of PNALD was 8.8% （ 8/91 ） in patients receiving parenteral regiment without lipid and 17.0% （53/311 ） in patients receiving parenteral nutrition with lipid, and there was no significant difference in prevalence of PNALD between two groups （X2 = 3.72, P = 0.07 ）. Lipid type and amount showed no significant effects on PNALD （ P 〉 0.05 ）. The fever days （ P 〈 0. 001 ）, baseline level of alanine transaminase （ P 〈0. 001 ） and γ-glutamyltransferase （ P 〈0. 001 ） were risk factors for liver injury by logistic regression. Conclusion Lipid emulsion can be safely used in old tumor patients without affecting the occurrence of PNALD.

关 键 词：老年 肿瘤 肠外营养相关肝损伤 脂肪乳剂 

分 类 号：R459.3[医药卫生—治疗学]