[Protective effect of essential phospholipids on liver injury due to total parenteral nutrition]

Abstract

Objective: It is known that total parenteral nutrition (TPN) causes liver damage by various mechanisms and leads to an increase of transaminases and obstructional enzymes. From this aspect TPN can be considered an external factor which causes liver damage. In our investigation we wanted to find out whether parenteral administration of essential phospholipids (EPL) can have a protective effect on this damage.

Patients and methods: Our investigation comprised 20 patients where TPN was indicated, usually on account of severe acute exacerbation of a non-specific inflammation of the gut. The patients were divided into two groups. Ten patients were treated by intravenous administration of essential phospholipids (Essentiale, Aventis), 50 mg every 6 hours for a period of two weeks. The control group comprised ten patients without hepatoprotection. The bilirubin, ALT, AST, GMT, ALP values were assessed before the initiation of the study, on the seventh and fourteenth day. The results were statistically processed by the paired and non-paired t-test.

Results: The baseline results of the mentioned tests did not differ significantly between groups. Bilirubin and AST did not change significantly during the investigation. In the control group we found, as compared with baseline values, a significantly increase of ALT on the seventh and fourteenth day, a significantly increase of GMT on the seventh and fourteenth day and a slight non-significant rise of ALP on the fourteenth day. In the ELP treated group, as compared with baseline values, a significant rise of ALT occurred on the fourteenth day. We did not observe a significant rise of GMT and ALP. Between the ELP treated and control group a significant increase of GMT and ALP occurred in the control group, the other values did not differ between groups.

Conclusion: Parenteral EPL administration can have a favourable effect on liver damage caused by TPN, associated with cholestasis and biliary sludge. This conclusion can be hypothetically explained by improved bile fluidity and protection of the bile pole of the hepatocyte by essential phospholipids. Therefore their administration during TPN can be recommended.