While TPN (total parenteral nutrition) can be life-saving for individuals with severe or long-term intestinal failure, it can also lead to a potentially life-threatening condition called transaminitis. Transaminitis is more commonly known as elevated liver enzymes.
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In this article, we will discuss elevated liver enzymes in individuals receiving TPN疗法.
A Quick Overview of Elevated Liver Enzymes
Transaminitis, or elevated liver enzymes, occurs when the levels of one or both key liver enzymes, alanine transaminase (ALT) and aspartate transaminase (AST), are elevated above the normal range.
ALT and AST belong to a family of enzymes called transaminases, or aminotransferases. The liver needs these enzymes to break down substances and remove toxic chemicals from the body.
转氨酶升高并非一种疾病，而是肝细胞受损的征兆。多种疾病会导致转氨酶升高，例如：
- 肝脏脂肪堆积
- 病毒性肝炎
- 酗酒
- 某些药物导致的肝损伤
Below, we will examine the occurrence of elevated liver enzymes in patients receiving total parenteral nutrition.
进一步阅读： TPN 与肝损伤：全面概述
TPN and Transaminitis: Are Elevated Liver Enzymes Common?
Can TPN cause elevated liver enzymes? An increase in blood transaminase levels is one of the most frequent TPN-associated issues. It typically occurs during the first 2 to 3 weeks after starting TPN [1].
其他与 TPN 相关的疾病包括：
- 脂肪变性（脂肪肝）
- 胆汁淤积（胆汁流动减慢）
- 胆结石
How TPN Can Cause Elevated Liver Enzymes
人们认为有几种机制会导致长期 TPN 期间的肝损伤。
长期接受TPN治疗的患者血液中胆碱水平通常较低。胆碱缺乏与脂肪变性（脂肪肝）和转氨酶升高有关。2][3].
一些研究表明，补充胆碱可能有助于逆转这些与 TPN 相关的异常。
另请阅读： TPN 与胆汁淤积：7 个常见问题
The risk of elevated liver enzymes may be higher in individuals receiving first-generation, soybean-based lipid preparations. In contrast, second-generation and third-generation preparations appear to carry a lower risk.
此外，TPN制剂中的矿物质，例如铜和锰，可能会在肝脏中积聚。过量的这些矿物质会导致肝酶升高，甚至肝损伤。
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TPN and Transaminitis: Strategies To Manage Elevated Liver Enzymes During Long-Term TPN Therapy
If you or anyone you love has TPN-associated elevated liver enzymes, your provider may [4]:
- 治疗潜在的肝病。
- 建议您尽量避免使用可能损害肝细胞的药物，例如抗生素、止痛药和某些草药制剂。
- 治疗细菌过度生长。
- 避免喂食过多。
- 调整 TPN 配方的脂质（脂肪）含量。
- 开出特定药物来减少肝损伤。
- 尽可能改用肠内营养。
您的医疗服务提供者也可能决定使用一种称为 循环 TPN。与持续的 TPN 不同，这种方法可以让您的身体进行“代谢”休息，让您的肝脏得到治愈。
根据 2017 年的一项研究，环状 TPN 可显著降低 ALT 和 AST 水平 [5].
Likewise, using SMOFlipid as part of the TPN formulation — an injectable lipid emulsion — can help reduce ALT and AST levels in children [6].
关键点
- Transaminitis (elevated liver enzymes) is one of the most common TPN-associated complications.
- Other factors, such as heavy drinking and hepatitis, can also cause elevated liver enzymes.
- 虽然转氨酶升高不是一种疾病，但它是肝损伤的最早迹象之一。
- TPN-associated transaminitis is thought to occur, in part, due to choline deficiency.
- Several measures can help improve elevated liver enzymes. These include treating underlying liver disease, avoiding overfeeding, and switching to cyclic TPN.
参考：
- Grau, T.、Bonet, A.、Rubio, M. 等。危重患者人工营养相关肝功能障碍。《急诊护理》11, R10 (2007)。https://doi.org/10.1186/cc5670
- Shronts, E P. “胆碱的本质及其对全肠外营养的影响。”《美国饮食协会杂志》第97卷,第6期(1997): 639-46, 649; quiz 647-8。doi:10.1016/S0002-8223(97)00161-2
- Buchman, AL 等。“胆碱缺乏导致接受肠外营养的患者出现可逆性肝脏异常：人类胆碱需求的证明：一项安慰剂对照试验。” JPEN。《肠外和肠内营养杂志》第 25,5 卷 (2001): 260-8。doi:10.1177/0148607101025005260
- Gabe, SM 和 A Culkin。“肠外营养患者肝功能检查结果异常。”《胃肠病学前沿》第1、2卷 (2010): 98-104. doi:10.1136/fg.2009.000521
- Arenas Villafranca, JJ、Nieto Guindo, M.、Álvaro Sanz, E. 等人。循环肠外营养对肠外相关肝功能障碍参数的影响。营养杂志 16, 66 (2017)。 https://doi.org/10.1186/s12937-017-0289-7
- Kitazawa, Chelsey；Bates, Kara；Lew, Shannon，“Smoflipid对肠衰竭相关肠外营养相关肝病(PNALD)患儿肝功能的有效性”(2018)。罗马琳达大学研究报告。14.
