新生儿使用多种油脂肪乳与中长链脂肪乳对肠外营养相关肝病影响的Meta分析

Effects of soybean oil-medium chain triglycerides-olive oil-fish oil vs medium/ long chain triglycerides emulsions on parenteral nutrition-associated liver disease in neonates: a Meta-analysis

摘要

目的: 通过系统评价比较新生儿使用多种油脂肪乳(soybean oil-medium chain triglycerides-olive oil-fish oil,SMOF)和中长链脂肪乳(medium/long chain triglycerides,MCT/LCT)对肠外营养相关肝病的影响,为临床用药提供循证依据。方法: 系统检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library、Web of Science数据库,检索时间为建库至2024年12月30日,纳入使用肠外营养≥7 d的新生儿,对符合纳排标准的随机对照试验进行质量评估和数据提取,使用R4.3.3、Stata14对数据进行分析。结果: 研究共纳入7项随机对照试验,涉及963例患儿。在肝酶方面,与MCT/LCT组相比,静脉输注SMOF的患儿谷丙转氨酶(SMD=-0.73,95%CI:-1.34~-0.12,P=0.018 7)、谷氨酰转移酶(SMD=-0.89,95%CI:-1.33~-0.45,P＜0.000 1)水平更低,谷草转氨酶、碱性磷酸酶水平与MCT/LCT组相当;在胆红素方面,SMOF组的直接胆红素水平更低(SMD=-0.61,95%CI=-0.88~-0.34,P＜0.000 1)、总胆红素水平两组并无差异;在血脂方面,SMOF组三酰甘油水平低于MCT/LCT组(SMD=-2.89,95%CI=-3.80~-1.97,P＜0.000 1),总胆汁酸水平相近;在胆汁淤积发生率方面,静脉输注SMOF的患儿相较于使用MCT/LCT的患儿有显著改善(OR=0.54,95%CI=0.36~0.84,P=0.005 4);此外,相较于MCT/LCT,SMOF不会增加脓毒症、坏死性小肠结肠炎、支气管肺发育不良等其他常见严重不良事件的发生率,两组患儿的死亡率无显著差异。结论: 与MCT/LCT相比,SMOF能够改善新生儿的肠外营养相关肝病,安全性更佳。

Abstract

Objective: To systematically compare the effects of soybean oil-medium chain triglycerides-olive oil-fish oil (SMOF) and medium/long chain triglycerides (MCT/LCT) on parenteral nutrition-associated liver disease (PNALD) in neonates, thus to provide evidence-based guidance for clinical practice. Methods: A comprehensive search was conducted in databases including CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, and Web of Science, covering studies published from inception to December 30, 2024. Randomized controlled trials (RCTs) involving neonates receiving parenteral nutrition for ≥7 d were included. Eligible studies were assessed for quality, and data were extracted for analysis using R4.3.3 and Stata 14. Results: Seven RCTs involving 963 neonates were included. Compared to the MCT/LCT group, the SMOF group showed significantly lower levels of alanine aminotransferase (ALT) (SMD=-0.73, 95%CI: -1.34 to -0.12, P=0.018 7) and gamma-glutamyl transferase (GGT) (SMD=-0.89, 95%CI: -1.33 to -0.45, P<0.000 1), while aspartate aminotransferase and alkaline phosphatase levels were comparable between groups. In terms of bilirubin, the SMOF group had lower direct bilirubin levels (SMD=-0.61, 95%CI=-0.88 to -0.34, P＜0.000 1), but no significant difference was observed in total bilirubin. Regarding lipid metabolism, triglyceride levels were lower in the SMOF group (SMD=-2.89, 95%CI: -3.80 to -1.97, P<0.000 1), whereas total bile acid levels were similar. The incidence of cholestasis was significantly reduced in the SMOF group (OR=0.54, 95%CI: 0.36 to 0.84, P=0.005 4). Additionally, SMOF did not increase the risk of sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, or other severe adverse events compared to MCT/LCT, and there was no significant difference in mortality between the two groups. Conclusion: Compared to MCT/LCT, SMOF improves PN-associated liver disease in neonates with a better safety profile.

关键词

新生儿 / 多种油脂肪乳 / 中长链脂肪乳 / 肠外营养相关肝病 / 安全性 / Meta分析

Key words

newborn / soybean oil-medium chain triglycerides-olive oil-fish oil / medium/long chain triglycerides / parenteral nutrition-associated liver disease / safety / Meta-analysis