背景：大豆油脂肪乳因其组成成分中含有长链脂肪酸、植物固醇、高比例ω-6脂肪酸和低水平α-生育酚，可能影响免疫功能和促使肝脏损伤。而复方脂肪乳中含有中链脂肪酸、鱼油和/或橄榄油，以上成分提供了充足的必需脂肪酸、低浓度ω-6脂肪酸和低水平植物固醇。该系统回顾旨在明确在接受肠外营养儿童中，比较复方脂肪乳与大豆油脂肪乳，是否对胆红素水平、甘油三酯水平和感染发生率有较好的影响。

方法：本研究主要包括了对已发表文献的系统回顾。已获同质的数据足以完成对总胆红素和感染的荟萃分析。

结果：9篇研究满足入选标准。荟萃分析结果表明：与大豆油脂肪乳相比，复方脂肪乳降低总胆红素平均2.09mg/dL（95%可信区间，-4.42～0.24），但该结果无统计学显著性（P=0.08）。荟萃分析结果显示：复方脂肪乳组和大豆油脂肪乳组的感染发生率无统计学显著性差异（P=.846）。将甘油三酯作为观察结果之一的4篇文献未见复方脂肪乳组和大豆油脂肪乳组的甘油三酯水平有显著差异。

结论：复方脂肪乳对胆红素水平、甘油三酯水平或感染发生率比大豆油脂肪乳更有优势的证据不充分。

JPEN J Parenter Enteral Nutr. 2015;39(6):656-67.

Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis.

Finn KL, Chung M, Rothpletz-Puglia P, Byham-Gray L.

State University of New Jersey, Cranford, New Jersey.

Tufts University, Medford, Massachusetts.

BACKGROUND: Soybean oil lipid emulsion may compromise immune function and promote hepatic damage due to its composition of long-chain fatty acids, phytosterols, high proportion of ω-6 fatty acids, and low α-tocopherol levels. Combination lipid emulsions have been developed using medium-chain triglyceride oil, fish oil, and/or olive oil, which provide adequate essential fatty acids, a smaller concentration of ω-6 fatty acids, and lower levels of phytosterols. The purpose of this systematic review is to determine if combination lipid emulsions have a more favorable impact on bilirubin levels, triglyceride levels, and incidence of infection compared with soybean oil lipid emulsions in children receiving parenteral nutrition.

METHODS: This study comprises a systematic review of published studies. Data were sufficient and homogeneous to conduct a meta-analysis for total bilirubin and infection.

RESULTS: Nine studies met the inclusion criteria. Meta-analysis showed that combination lipid emulsion decreased total bilirubin by a mean difference of 2.09 mg/dL (95% confidence interval, -4.42 to 0.24) compared with soybean oil lipid emulsion, although the result was not statistically significant (P = .08). Meta-analysis revealed no statistically significant difference in incidence of infection between the combination lipid emulsion and the soybean oil lipid emulsion groups (P = .846). None of the 4 studies that included triglyceride as an outcome detected a significant difference in triglyceride levels between the combination lipid emulsion and soybean oil lipid emulsion groups.

CONCLUSION: There is inadequate evidence that combination lipid emulsions offer any benefit regarding bilirubin levels, triglyceride levels, or incidence of infection compared with soybean oil lipid emulsions.

KEYWORDS: lipids; parenteral nutrition; pediatrics

PMID: 25057053

DOI: 10.1177/0148607114542515