腺苷蛋氨酸治疗全肠外营养并发胆汁瘀积

目的：观察腺苷蛋氨酸（SAMe)对全肠外营养（TPN）并发胆汁瘀积的防治效果。方法：30只大鼠分为对照组（I）,高热卡组（Ⅱ）,高热卡组加SAMe组（Ⅲ）,感染组（Ⅳ）,感染加SAMe组（Ⅴ）,比较各组胆汁瘀积的情况。临床用SAMe治疗16例应用TPN＞4周,发生胆汁瘀积的患者,观察胆汁瘀积的缓解。结果：II组和IV组大鼠出现胆汁流下降,血清总胆酸和γ－谷胺酰转肽酶（γ-GT）水平明显升高,肝细胞脂肪变性,毛细胆管扩张及胆栓,而给予SAMe的Ⅲ,Ⅴ组胆汁流升高,血清总胆酸和γ－GT水平明显降低,肝脏病理结果正常,毛细胆管不扩张,无胆栓,临床16例患者给药前表现为胆汁瘀积和肝功能损害,给阳SAMe3周后血总胆红素,碱性磷酸酶,γ－GT,谷丙转氨酶,谷草转氨酶均较给药前的异常水平有显著下降,第4周恢复至正常水平。结论：SAMe可以在不终止TPN的情况下防治胆汁瘀积。

Laboratory investigation and clinical application of S-adenosyl-L-methionine in the treatment of cholestasis after total parenteral nutrition

Objective To observe the therapeutic effects of S Adenosyl L methionine(SAMe) in the treatment of cholestasis after total parenteral nutrition (TPN). Methods Thirty SD rats were randomly divided into control group, hypercalorie group, hypercalorie adds SAMe group; sepsis group and sepsis adds SAMe group; their stages of cholestasis were compared. Sixteen patients received SAMe because of cholestasis after prolonged TPN. Results Bile flow, serum levels of total bile acid and gamma glutamyl transpeptidase were elevated markedly in hypercalorie and sepsis groups. Hepatocellular fatty degeneration, dilatation of cholangiole, and bile sludge could be seen microscopically, while SAMe administration in hypercalorie adds SAMe and sepsis adds SAMe groups could increase bile flow, decrease serum total bile acid and gamma glutamyl transpeptidase levels. Microscopic findings were normal, no dilated cholangiole or bile sludge could be found. Cholestasis and abnormal results of liver function test were the main clinical manifestations of 16 patients before SAMe administration. Three weeks after SAMe administration, their serum levels of total bilirubin, alkaline phosphotase, gamma glutamyl transpeptidase, alanine aminotransferase(ALT), and aspartate aminotransferase(AST) were decreased markedly; they became normal in the 4 th week. Conclusion SAMe could prevent and treat cholestasis without discontinuation of TPN.