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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (06) : 641 -646. doi: 10.3877/cma.j.issn.1673-5250.2020.06.004

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鱼油脂肪乳制剂治疗肠衰竭相关性肝病的研究现状
马忠扬1, 王浩然2, 岳艳1, 张莉1,†(), 母得志1   
  1. 1. 四川大学华西第二医院儿科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
    2. 四川大学华西临床医学院，成都　610041
  • 收稿日期:2020-07-01 修回日期:2020-11-12 出版日期:2020-12-01
  • 通信作者: 张莉

Current status on treatment of intestinal failure-associated liver disease by fish oil lipid emulsion

Zhongyang Ma1, Haoran Wang2, Yan Yue1, Li Zhang1,†(), Dezhi Mu1   

  1. 1. Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    2. West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-07-01 Revised:2020-11-12 Published:2020-12-01
  • Corresponding author: Li Zhang
  • Supported by:
    National Natural Science Foundation of China(81630038, 81971433)
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马忠扬, 王浩然, 岳艳, 张莉, 母得志. 鱼油脂肪乳制剂治疗肠衰竭相关性肝病的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(06): 641-646.

Zhongyang Ma, Haoran Wang, Yan Yue, Li Zhang, Dezhi Mu. Current status on treatment of intestinal failure-associated liver disease by fish oil lipid emulsion[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(06): 641-646.

肠外营养(PN)是维持肠道功能障碍患儿生命的重要手段。但是，若患儿长期依赖PN，则可能导致严重并发症，如肠衰竭相关性肝病(IFALD)等。脂肪乳是PN制剂的重要组成成分。研究表明，第1代脂肪乳制剂(豆油脂肪乳制剂)是导致IFALD发生的原因之一，而第4代脂肪乳制剂(鱼油脂肪乳制剂)不仅无此不良反应，而且还可用于IFALD治疗。笔者拟对目前鱼油脂肪乳制剂治疗IFALD的有效性及安全性的研究现状进行阐述，旨在为临床对PN患儿的脂肪乳制剂选择提供参考。

关键词: 鱼油, 脂肪乳剂, 静脉注射用, 胃肠外营养, 肠衰竭相关性肝病, 儿童

Parenteral nutrition (PN) is an important measure to maintain the life of children with intestinal dysfunction. However, long-term dependence on PN may lead to serious complications, such as intestinal failure-associated liver disease (IFALD). Lipid emulsion is one of important components of PN. Studies have shown that the first generation of lipid emulsion (soybean oil lipid emulsion) is one of the causes of IFALD. While the fourth generation of lipid emulsion (fish oil lipid emulsion) not only has no this side effect, but also could be used for treatment of IFALD. This paper summarizes the recent studies on the efficacy and safety of fish oil lipid emulsion in treatment of IFALD, in order to provide evidences for clinical application of fish oil lipid emulsion.

Key words: Fish oils, Fat emulsions, intravenous, Parenteral nutrition, Intestinal failure-associated liver disease, Child
[1]
Yap JYK, Roberts AJ, Bines JE. Paediatric intestinal failure and transplantation[J]. J Paediatr Child Health, 2020，56(11):1747-1753. DOI: 10.1111/jpc.15052.
[2]
Mutanen A, Lohi J, Merras-Salmio L, et al. Prediction, identification and progression of histopathological liver disease activity in children with intestinal failure[J]. J Hepatol, 2020，28(20):33666-33667. DOI: 10.1016/j.jhep.2020.09.023.
[3]
Gura KM, Mulberg AE, Mitchell PD, et al.Pediatric intestinal failure-associated liver disease: challenges in identifying clinically relevant biomarkers[J]．JPEN J Parenter Enteral Nutr, 2018, 42(2): 455-462. DOI: 10.1177/0148607116671781.
[4]
Courtney CM, Warner BW.Pediatric intestinal failure-associated liver disease[J]. Cur Opin Pediatr, 2017，29(3):363-370. DOI: 10.1097/MOP.0000000000000484.
[5]
Zambrano E, El-Hennawy M, Ehrenkranz RA, et al.Total parenteral nutrition induced liver pathology: an autopsy series of 24 newborn cases[J]. Pediatr Dev Pathol, 2004, 7(5):425-432. DOI: 10.1007/s10024-001-0154-7.
[6]
Fundora J, Aucott S. Intestinal failure-associated liver disease in neonates[J]. Neoreviews, 2020，21(9):e591-e599. DOI: 10.1542/neo.21-9-e591.
[7]
Lavallee CM, MacPherson JAR, Zhou M, et al.Lipid emulsion formulation of parenteral nutrition affects intestinal microbiota and host responses in neonatal piglets[J]. JPEN J Parenter Enteral Nutr, 2017，41(8):1301-1309. DOI：10.1177/0148607116662972.
[8]
Al-Shahwani NH, Sigalet DL.Pathophysiology, prevention, treatment, and outcomes of intestinal failure-associated liver disease[J]．Pediatr Surg Int, 2017，33(4):405-411. DOI: 10.1007/s00383-016-4042-7.
[9]
Wang P, Wang Y, Lu L, et al.Alterations in intestinal microbiota relate to intestinal failure-associated liver disease and central line infections[J]．J Pediatr Surg, 2017，52(8):1318-1326. DOI：10.1016/j.jpedsurg.2017.04.020.
[10]
Vanek VW, Seidner DL, Allen P, et al.A.S.P.E.N. position paper: clinical role for alternative intravenous fat emulsions[J]．Nutr Clin Pract，2012，27(2):150-192. DOI: 10.1177/0884533612439896.
[11]
Raman M, Almutairdi A, Mulesa L, et al.Parenteral nutrition and lipids[J]. Nutrients, 2017，9(4):388. DOI：10.3390/nu9040388.
[12]
Turner JM, Josephson J, Field CJ, et al.Liver Disease, systemic inflammation, and growth using a mixed parenteral lipid emulsion, containing soybean oil, fish oil, and medium chain triglycerides, compared with soybean oil in parenteral nutrition-fed neonatal piglets[J]. JPEN J Parenter Enteral Nutr, 2016，40(7):973-981. DOI：10.1177/0148607115579711.
[13]
Lee WS, Chew KS, Ng RT, et al.Intestinal failure-associated liver disease (IFALD): insights into pathogenesis and advances in management[J]．Hepatol Int，2020，14(3):305-316. DOI: 10.1007/s12072-020-10048-8.
[14]
Goulet OJ, Cai W, Seo JM. Lipid emulsion use in pediatric patients requiring long-term parenteral nutrition[J]．JPEN J Parenter Enteral Nutr, 2020，44(Suppl 1):S55-S67. DOI: 10.1002/jpen.1762.
[15]
Lavallee CM, Lim DW, Wizzard PR, et al.Impact of clinical use of parenteral lipid emulsions on bile acid metabolism and composition in neonatal piglets[J]. JPEN J Parenter Enteral Nutr, 2019, 43(5): 668-676. DOI：10.1002/jpen.1437.
[16]
Ishihara T, Yoshida M, Arita M．Omega-3 fatty acid-derived mediators that control inflammation and tissue homeostasis[J]．Int Immunol, 2019，31(9): 559-567. DOI: 10.1093/intimm/dxz001.
[17]
Costa S, Iannotta R, Maggio L, et al.Fish oil-based lipid emulsion in the treatment of parenteral nutrition-associated cholestasis[J]. Italian J Pediatr，2018，44(1):101. DOI: 10.1186/s13052-018-0539-0.
[18]
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 Nutrit，2018，72(10):1364-1372. DOI：10.1038/s41430-018-0096-z.
[19]
Honeywell S, Zelig R, Rigassio Radler D. Impact of intravenous lipid emulsions containing fish oil on clinical outcomes in critically Ⅲ surgical patients: a literature review[J]. Nutr Clin Pract, 2019, 34(1): 112-122. DOI: 10.1002/ncp.10224.
[20]
Lam HS, Tam YH, Poon TCW, et al.A double-blind randomised controlled trial of fish oil-based versus soy-based lipid preparations in the treatment of infants with parenteral nutrition-associated cholestasis[J]．Neonatology, 2014，105(4):290-296. DOI：10.1159/000358267.
[21]
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.
[22]
Soden JS, Lovell MA, Brown K, et al.Failure of resolution of portal fibrosis during omega-3 fatty acid lipid emulsion therapy in two patients with irreversible intestinal failure[J]．J Pediatr，2010, 156(2): 327-331. DOI：10.1016/j.jpeds.2009.08.033.
[23]
Belza C, Thompson R, Somers GR, et al.Persistence of hepatic fibrosis in pediatric intestinal failure patients treated with intravenous fish oil lipid emulsion[J]. J Pediatr Surg, 2017，52(5): 795-801.DOI: 10.1016/j.jpedsurg.2017.01.048.
[24]
Wang C, Venick RS, Shew SB, et al. Long-term outcomes in children with intestinal failure-associated liver disease treated with 6 months of intravenous fish oil followed by resumption of intravenous soybean oil[J]. JPEN J Parenter Enteral Nutr, 2019，43(6):708-716. DOI: 10.1002/jpen.1463.
[25]
Khalaf RT, Sokol RJ.New insights into intestinal failure-associated liver disease in children[J]. Hepatology, 2020，71(4):1486-1498. DOI: 10.1002/hep.31152.
[26]
Riedy M, DePaula B, Puder M, et al.Higher doses of fish oil-based lipid emulsions used to treat inadequate weight gain and rising triene：tetraene ratio in a severely malnourished infant with intestinal failure-associated liver disease[J]．JPEN J Parenter Enteral Nutr，2017，41(4):667-671. DOI: 10.1177/0148607116661031.
[27]
Gura KM, Calkins KL, Puder M．Use of fish oil intravenous lipid emulsions as monotherapy in the pediatric intestinal failure patient: beyond the package insert[J]．Nutr Clin Pract，2020，35(1): 108-118. DOI: 10.1002/ncp.10413.
[28]
Le HD, de Meijer VE, Zurakowski D, et al.Parenteral fish oil as monotherapy improves lipid profiles in children with parenteral nutrition-associated liver disease[J]. JPEN J Parenter Enteral Nutr，2010，34(5):477-484. DOI: 10.1177/0148607110371806.
[29]
Nandivada P, Baker MA, Mitchell PD, et al.Predictors of failure of fish-oil therapy for intestinal failure-associated liver disease in children[J]．Am J Clin Nutr，2016，104(3): 663-670. DOI: 10.3945/ajcn.116.137083.
[30]
Calkins KL, Dunn JC, Shew SB, et al. Pediatric intestinal failure-associated liver disease is reversed with 6 months of intravenous fish oil[J]. JPEN J Parenter Enteral Nutr, 2014，38(6):682-692. DOI: 10.1177/0148607113495416.
[31]
Lapillonne A, Fidler Mis N, Goulet O, et al.ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: lipids[J]．Clin Nutr，2018，37(6 Pt B): 2324-2336. DOI: 10.1016/j.clnu.2018.06.946.
[32]
Raphael BP, Mitchell PD, Gura KM, et al.Growth in infants and children with intestinal failure-associated liver disease treated with intravenous fish oil[J]．J Pediatr Gastroenterol Nutr, 2020，70(2):261-268. DOI: 10.1097/MPG.0000000000002551.
[33]
Biagetti C, Correani A, D′Ascenzo R, et al.Does intravenous fish oil affect the growth of extremely low birth weight preterm infants on parenteral nutrition？[J]. Clin Nutr, 2019, 38(5):2319-2324. DOI：10.1016/j.clnu.2018.10.009.
[34]
Gura K, Premkumar MH, Calkins KL, et al.Intravenous fish oil monotherapy as a source of calories and fatty acids promotes age-appropriate growth in pediatric patients with intestinal failure-associated liver disease[J]. J Pediatr, 2020，219:98.e4-105.e4. DOI: 10.1016/j.jpeds.2019.12.065.
[35]
Carta G, Murru E, Vargiu R, et al.Essential fatty acids deficient diet modulates N-Acylethanolamide profile in rat′s tissues[J]．Prostaglandins Leukot Essent Fatty Acids，2020，153: 102053. DOI：10.1016/j.plefa.2020.102053.
[36]
Olthof ED, Roelofs HM, Fisk HL, et al.No clinical or biochemical evidence for essential fatty acid deficiency in home patients who depend on long-term mixed olive oil- and soybean oil-based parenteral nutrition[J]. JPEN J Parenter Enteral Nutr, 2016，40(7):982-988.DOI：10.1177/0148607115581375.
[37]
Gramlich L, Ireton-Jones C, Miles JM, et al.Essential fatty acid requirements and intravenous lipid emulsions[J]. JPEN J Parenter Enteral Nutr, 2019，43(6):697-707. DOI：10.1002/jpen.1537.
[38]
Lezo A, D′Onofrio V, Puccinelli MP, et al. Plasma and red blood cell PUFAs in home parenteral nutrition paediatric patients-effects of lipid emulsions[J]. Nutrients, 2020，12(12):E3748. DOI: 10.3390/nu12123748.
[39]
Ong ML, Venick RS, Shew SB, et al.Intravenous fish oil and serum fatty acid profiles in pediatric patients with intestinal failure-associated liver disease[J]. JPEN J Parenter Enteral Nutr，2019, 43(6):717-725. DOI: 10.1002/jpen.1532.
[40]
Dicken BJ, Bruce A, Samuel TM, et al.Bedside to bench: The risk of bleeding with parenteral omega-3 lipid emulsion therapy[J]．J Pediatr，2014，164(3):652-654. DOI：10.1016/j.jpeds.2013.10.066.
[41]
Turner JM, Field CJ, Goruk S, et al.Platelet arachidonic acid deficiency may contribute to abnormal platelet function during parenteral fish oil monotherapy in a piglet model[J]．JPEN J Parenter Enteral Nutr，2016，40(4): 587-591. DOI: 10.1177/0148607114568670.
[42]
Dao DT, Anez-Bustillos L, Finkelstein AM, et al.Trends of INR and fecal excretion of vitamin K during cholestasis reversal: implications in the treatment of neonates with intestinal failure-associated liver disease[J]. JPEN J Parenter Enteral Nutr，2020，44(5):951-958. DOI：10.1002/jpen.1677.
[43]
Nandivada P, Anez-Bustillos L, O′Loughlin AA, et al.Risk of post-procedural bleeding in children on intravenous fish oil[J]．Am J Surg，2017，214(4):733-737. DOI: 10.1016/j.amjsurg.2016.10.026.
[44]
Akintoye E, Sethi P, Harris WS, et al.Fish oil and perioperative bleeding[J]．Circ Cardiovasc Qual Outcomes，2018, 11(11):e004584. DOI: 10.1161/CIRCOUTCOMES.118.004584.
[45]
Gura KM. The power of networking and lessons learned from omegaven[J]. J Pediatr Pharmacol Ther, 2020，25(8):663-674. DOI: 10.5863/1551-6776-25.8.663.
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