Liver Function Tests Abnormalities in Adult Patients with Total Parenteral Nutritional Therapy

全靜脈營養對成人肝臟生化功能之影響

張維國(Wei-Kuo Chang) ； 唐鴻舜(Hung-Shung Tang) ； 趙有誠(You-Chen Chao) ； 葉淳(Chun Yeh) ； 曹為霖(Wei-Lin Tsao) ； 張子明(Sheng-Shung Tsao) ； 鄒順生(Tzu-Ming Chang) ； 許重得(Chung-Te Hsu)

《Journal of Medical Sciences》 16卷4期 (1996/02) Pp. 231-238

摘要

接受全靜脈營養之患者，常有肝臟生化功能異常的現象。本文選擇無肝、膽、胰臟疾病之正常肝生化功能之成人患者，接受二星期以上全靜脈營養33名，觀察其肝臟生化功能之變化情形。施予全靜脈營養之患者，於第一星期肝臟生化功能即有異常現常。於第四星期可見血清麩草酸酶（AST）平均值為82.8±169.2 U／L，其中38.5%有偏高現象；鹼性磷酸酶平均值為173.9±91.2U／L，其中80.8%有偏高現象；膽色素平均值為0.6±0.4 mg／dl，其中11.5%有偏高現象。觀察接受全靜脈營養的患者，其肝臟生化功能異常以鹼性磷酸酶變化較為明顯。接受全靜脈營養患者約有一半有感染症狀;其肝臟生化功能變化的程度較無感染者嚴重;部份患者甚至有持續性惡化的現象。因此早期診斷及避免可能引起肝功能異常的因素，對接受全靜脈營養的患者應有助益。

關鍵字

全靜脈營養 ； 肝臟生化功能

並列摘要

Thirty three adult patients with normal liver function tests (LFTs) prior to total parenteral nutrition (TPN) therapy were included in this study. The average duration of patients receivingTPN therapy was 31.3 days. During TPN therapy in most of the patients, there were progressive increase extent and frequent abnormality of aspartate aminotransferase (AST) and alkaline phosphatase levels, but little change in albumin and bilirubin levels. The abnormality of LFTs may develop as early as one week after TPN therapy. On one week of TPN therapy, the incidence of abnormal AST. bilirubin and alkaline phosphatase were 10%. 9.1% and 38.1% respectively. On 4 weeks of TPN therapy, the incidence of abnormal LFTs and its mean values were: AST (38.5%, 82.8±169.2 U/L), bilirubin (11.5%, 0.6±0.4 mg/dl) and alkaline phosphatase (80.89%, 173.9±91.2 U/L), respectively. The AST increased significantly from the baseline of 24.9±15.4 U/L to the peak of 115.2±219.5 U/L at week 5 (p＜0.01). The alkaline phosphatase increased significantly from baseline of 76.3±28.3 U/L to 162.1±87.8 U/L, 173.9±91.2 U/L and 181.6±104.6 U/L for weeks 3, 4 and 5 respectively (P＜0.01). The albumin level increased significantIy from weeks 2 and 3 to weeks 6 and 7 by TPN therapy respectively (P＜0.01). About half of these patients developed clinical symptom and signs of sepsis. The overall abnormal LFTs appeared more common and severe in septic patients than that of nonseptic patients. In conclusion. A gradual rise in bilirubin, AST, or alkaline phosphatase may be expected in many patients receiving TPN therapy. Some of them may develop into severe and progressive liver function impairment. Early detection and correcting the possible factors that may induce hepatic dysfunction such as sepsis may be benefit in the prevention the abnormal LFTs during TPN therapy.

並列關鍵字

total parenteral nutrition ； liver function tests