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題名 | Total Parenteral Nutrition-Associated Cholestasis in Infants: Clinical and Liver Histologic Studies=嬰兒完全靜脈營養之相關膽汁滯留:臨床及肝臟病理之研究 |
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作者 | 周怡宏; 鄒國英; 許輝吉; 張美惠; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 34:4 民82.07-08 |
頁次 | 頁264-271 |
分類號 | 417.545 |
關鍵詞 | 完全靜脈營養; 肝臟; 病理; 滯留; 嬰兒; 膽汁; |
語文 | 英文(English) |
中文摘要 | 嬰幼兒尤其早產兒常易因完全靜脈營養導致肝臟之膽汁滯留。我們回顧台大醫院小兒科在過去十年間所經歷之十五例經病理診斷符合之本症患嬰。病例之平均懷孕週數為32.1週(26-40)週,平均出生體重則為1807克(840-5840克)。三分之二的病例接受TPN之期間多於或等於60天。自開始用TPN至直接型膽紅素之異常升高(>l.5 mg/dl)之平均週數為4.53士2.42(2-9)週。自開始TPN至直接型膽紅素升至最高值之週數平均為14.73±7.33 (6-33)週。接受TPN期間之平均能量,醣類,蛋白質及脂肪供給量為94±13 (72-110)卡/公斤/天,14.9±3.9克/公斤/天,1.98±0.42克/公斤/天,以及1.87±0.37克/公斤/天。肝臟之主要病理變化為膽汁滯留,門脈週圍之發炎,纖維化以及細膽管之增生。其存活率為60%,另40%則因罹患其他與TPN不相關之疾患而死亡。存活者之膽紅素在停止TPN之後平均14.0±9.4(8-34)週後可回復正常。吾人的結論是這種嬰兒的肝臟疾患,多半發生在早產兒使用較長的TPN者,其病程除少數外常為良性而可逆的。 |
英文摘要 | To evaluate total parenteral nutrition-associated cholestasis (TPN-C) in infants, a retrospective clinicopathologic study was conducted of 15 infants who had received TPN. The mean gestational age and birth weight were 32.1 weeks (26-40 weeks) and 1807g (840-5840g) respectively. Two-thirds of the patients were kept on TPN for more than 60 days. The onset of rising direct bilirubin ranged 2-9 weeks (mean 4.5±2.4) after TPN therapy. Preterm babies less than 32 weeks of age had an earlier rise of direct bilirubin and AST. Bile sludge of the gallbladder was observed in only one case, and none had gallstone. The main histologic findings of liver biopsy or autopsy were cholestasis (intracellular and canalicular), periportal inflammation, fibrosis and bile ductular proliferation. Sixty percent of these survived, the remaining 40% died of complications unrelated to TPN-C. The liver function profile became normalized within a mean of 14.0±9.4 (8-34) weeks after discontinuation of TPN in the survival cases. It was concluded that infant TPN-associated cholestasis was mostly reversible, but that the younger preterm babies were susceptible to a prolonged TPN course with more marked clinical and pathological changes. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。