신생아의 TPN 요법 시 발생되는 Cholestasis 치료를 위한 Ursodeoxycholic Acid의 약물사용 평가

• 영문명: Drug Evaluation of Ursodeoxycholic Acid Use for Treatment of Cholestasis Associated with TPN Therapy in Neonate
• 발행기관: 대한약학회
• 저자명: 이정옥(Jung Ok Lee) 송태범(Tae Beom Song) 이명구(Myung Koo Lee) 임성실(Sung Cil Lim)
• 간행물 정보: 『약학회지』제54권 제4호 (2010년), 270~281쪽, 전체 12쪽
• 주제분류: 의약학 > 기타의약학
• 파일형태: PDF
• 발행일자: 2010.08.31

영문 초록

Total parenteral nutrition (TPN) is necessary to neonates in neonatal intensive care unit (NICU) for survival and growth because of impossible of enteral feeding. Long-term TPN can be associated with a broad spectrum of hepatobiliary disorder, ranging from mild hepatic dysfunction to severe end-stage liver disease. Cholestasis developed most commonly in neonate, ursodeoxycholic acid (UDCA) is widely used in adult with cholestatic and non-cholestatic liver diseases but there have been limited data on the effects in neonate with PNAC. This study was performed retrospectively to review all medical histories of the total 30 neonates with was administrated UDCA for treatment to parenteral nutrition associated cholestasis (PNAC) at Chungbuk National University Hospital NICU from April 2002 to December 2008. UDCA was administrated at bilirubin is over 2 mg/dl. The criterias for drug evaluation were included hepatic biochemical marker such as direct bilirubin, total bilirubin, AST, ALT, ALP and GGT, TPN therapy period, cholestasis development period, UDCA treatment period, UDCA dosage and adverse effect. In the results, Post-UDCA treatment significant was decreased direct bilirubin, total bilirubin, AST and ALP (p<0.05), and was decreased GGT (p>0.05) and slightly was increased ALT (p>0.05). Reffective timect biDCA was appear at mean 10.5±1.3 days, iDCA administration period was mean 64.4±5.9 days, cholestasis period was mean 71.9±6.4 days and UDCA dosage was mean 22.9±0.9 mg/kg/day. Common adverse effects is diarrhea, 5 patients arised mild diarrhea but it possible also related with increased enteral feeding. In conclusion, iDCA can decrease direct bilirubin that major parameter t bcholestasis and oher hepatic biochemical makers. UDCA is effective on PNAC without any serious side effect and cost-effective. Although no greatly shortening cholestasis period, but can protect to develop into severe liver disease and other complication or death. Based on these result, UDCA is recommended for treatment of cholestasis at direct bilirubin is over 2 mg/dl.

키워드

TPN neonate NICU cholestasis UDCA liver disease PNAC direct bilirubin total bilirubin AST ALT ALP GGT