早产儿肠外营养相关性肝病的诊断与治疗  

Diagnosis and therapeutic strategies of parenteral nutrition-associated liver disease in premature infants

作　　者：胡玉莲[1] 胡长霞[1] Hu Yulian;Hu Changxia(Department of Neonatology,Hubei Maternity and Child Health Hospital,Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院新生儿科,武汉430070

出　　处：《中华实用儿科临床杂志》2018年第19期1454-1459,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：早产儿肠外营养相关性肝病是早产儿长期胃肠外营养最主要的并发症之一，其主要特征是结合胆红素≥34.2 μmol/L，伴或不伴肝酶异常，排除其他疾病。其常见危险因素包括胎龄、低出生体质量、胃肠外营养的持续时间、胃肠外营养成分、感染、胃肠疾病、基因易感性等。这种肝损害大多程度较轻，停止静脉营养会自愈，但也有少数会进展到肝纤维化。尽管熊去氧胆酸和鱼油来源的、富含ω-3 PUFA（n－6∶n－3＝1∶7）的脂肪乳剂可用于治疗肠外营养相关性肝病，但临床实际仍缺乏有效的预防、治疗肠外营养相关性肝病的策略，需不断寻找新的治疗手段。Parenteral nutrition-associated liver disease （PNALD） or cholestasis （PNAC）is the main complication of prolonged parenteral nutrition in premature infants.It is characterized by cholestatic jaundice, which is defined as direct serum bilirubin of ≥34.2 μmol/L with or without liver enzymes abnormalities, rule out other causes.The risk factors contributing to the incidence of PNALD are premature, low birth weight, the duration of parenteral nutrition（PN）, components of PN, sepsis, intestinal disease, genetic susceptibility.Although the damage is frequently mild, and resolves after discontinuation of parenteral nutrition, in some cases it progresses into cirrhotic changes.Ursodeoxycholic acid and lipid emulsions based on fish oil with a high content of long-chain polyunsaturated fatty acids ω-3 has been proposed to be efficacy.But effective preventive and therapeutic strategies for PNALD have not been established yet.Innovative therapeutic strategies needs to be investigated.

关 键 词：婴儿 早产 肠外营养相关性肝病 熊去氧胆酸 脂肪乳剂 

分 类 号：R722.6[医药卫生—儿科]