51 2 2017 4 55 特 集 Ⅰ はじめに intravenous fat emulsions IVFEs Ⅱ IVFEs の世代分類 図 1 American Society for Parenteral and Enteral Nutrition AS- PEN 1 IVFEs 2 IVFEs soybean oil SO medium chain triglyceride MCT olive oil OO fish oil FO 4 MCT IVFEs n 6 polyunsaturated fatty acid PUFA n 6 PUFA 1990 IVFEs 2 305 8575 1 1 1 Ⅲ 第 1 世代 IVFEs 誕生の歴史考証 1679 Curten 1915 3 IVFEs 1964 3 1965 Wretlind SO IVFEs Intralipid 50 3 Wretlind IVFEs parenteral nutrition PN lipid carbohydrate system 4 PN 1920 IVFEs Yanol 5 6 1949 Fatgen 6 1959 Fatgen D IVFEs 25 ml 4 Fatgen D
56 図 1 IVFEs 7 Fatgen D IVFEs SO Intralipid 7 2 Intrafat 1968 10 1970 1990 2011 Intralipos 1981 10 1987 IVFEs Ⅳ IVFEs 世代進化の原動力となった諸問題 IVFEs PN lipid carbohydrate system 4 PN IVFEs IVFEs 1 1 1 IVFEs 1 IVFEs SO 100 n 6 PUFA n 3 PUFA eicosapentaenoic acid EPA docosahexaenoic acid DHA 2 1990 IVFEs 2 PN SO IVFEs essential fatty acid deficiency EFAD 2012 2 8 90 9 SO IVFEs 3 PN associated liver disease PNALD PNALD PN IVFEs PN 2
51 2 2017 4 57 表 1IVFEs FA n 6 n 3 kcal/l 1 2 3 4 Intralipid Nutrilipid Lipofundin Lipovenoes Structolipid ClinOleic Clinolipid Lipidem Lipoplus SMOFlipid Omegaven 10 10 10 SO 100 SO 100 SO MCT 50 50 SO MCT 50 50 SO MCT 64 36 OO SO 80 20 OO SO 80 20 MCT SO FO 50 40 10 MCT SO FO 50 40 10 SO MCT OO FO 30 30 15 FO 100 9 1 9 1 2. 2. 2.5 1 1 8 1100 2000 2000 1022 1908 1950 1960 2000 2000 1910 1910 2000 1120 FA SO MCT OO FO PN PNALD 2 PNALD IVFEs phytosterol long chain triglyceride LCT 10 SO SO IVFEs 2 2 1 IVFEs MCT LCT structured triglyceride STG 3 2 STG SO LCT MCT MCT LCT 2 MCT 2 IVFEs 11 STG IVFEs LCT/MCT IVFEs 2 Pharmaconutrient Pharmaconutrient IVFEs FO DHA EPA pharmaconutrient 12 FO 4 IVFEs Ⅴ 世界で供給されている IVFEs の現況 表 1 2016 IVFEs 2 STG IVFEs Structolipid 3 IVFEs OO SO 8 2 OO n 9 65
58 4 IVFEs Omegaven FO IVFEs 10 PN FO 13 PNALD 14 clinicaltrials.gov NCT00512629 NCT 00910104 2017 1 SMOFlipid 4 SO MCT OO FO 1 IVFEs IVFEs 1 PN lipid carbohydrate system Glucose system IVFEs IVFEs 2013 Food and Drug Administration FDA 3 Clinolipid 1000 ml 2 4 Omegaven FDA FDA Ⅵ 臨床効果の検証 IVFEs IVFEs 1 IVFEs 1/2 4 IVFEs 2 3/4 IVFEs Edmuds 2007 2009 2011 International Nutrition Survey INS 12,585 451 72 48 PN 5 IVFEs PN 70 SO/ MCT/OO/FO PN 223 65 74 19 15 OO FO PN SO PN ICU FO PN 19 Manzanares 2 16 17 2014 1980 2012 randomized controlled trial RCT 6 PN LCT MCT FO IVFEs vs. LCT MCT IVFEs 1 LCT LCT/MCT FO IVFEs vs. LCT LCT MCT IVFEs 3 enteral nutrition EN EN FO IVFEs vs. EN EN FO IVFEs vs. EN
51 2 2017 4 59 1 390 16 FO IVFEs ICU RCT 2014 10 17 PN 6 LCT MCT FO IVFEs vs. LCT MCT IVFEs 3 LCT FO IVFEs vs. LCT IVFEs 2 OO FO IVFEs vs. OO IVFEs 1 EN 4 EN FO IVFEs vs. EN 1 EN FO IVFEs vs. EN 1 EN PN FO IVFEs vs. EN/PN/ 1 EN PN FO IVFEs vs. EN/PN 1 733 FO IVFEs EN RCT 5 RCT FO IVFEs 0.64 p 0.02 1 IVFEs 2 ASPEN 2016 1 SO IVFEs PN 1 1 100 g 18 2 Omegaven EFAD Omegaven 19 T PN 17 2 PN EFAD Omegaven FDA Omegaven 0.2 g/kg/day 0.67 g/kg/day 17 Triene Tetraene EN 46 Omegaven PN Omegaven EFAD 3 PNALD 4 IVFEs 2015 PNALD 4 IVFEs Omegaven SMOFlipid Lipidem 2014 5 3 93 4 1,012 4 IVFEs parenteral nutrition associated cholestasis PNAC 2 2 mg/dl
60 PNAC PNALD 2 2014 PNALD 6 21 2007 9 2013 4 97 Omegaven 1.0 g/ kg/day compassionate use 83 86 14 2015 2004 2012 PNALD Omegaven 1.0 g/kg/ day 12 178 51 29 22 51 76 74 6.4 4 0.2 0.1 mg/ dl PN Pediatric End Stage Liver Disease PELD scores 4 IVFEs PNALD 4 STG IVFEs 2016 2 IVFEs STG 11 5 7 PN STG IVFEs Structolipid LCT/MCT IVFEs Lipofudin Lipovenoes STG IVFEs ALT AST GGT 21 18 86 PubMed 16 76 4 1 Ⅶ 今後の展望 4 IVFEs personal communication IVFEs 表 1 2 IVFEs IVFEs 4 IVFEs SMOFlipid SMOFlipid PNALD Omegaven IVFEs 4 IVFEs 1
51 2 2017 4 61 2007 8 23 40 40 13 23 1 1 SMOFlipid Intralipos IVFEs Intralipos 1981 SMOFlipid SMOFlipid 2 1990 EN PN EN PN 2011 65 2,900 500 /65 4,900 1,000 2011 65 130 25 2 2011 Omegaven Omegaven Omegaven 1 1 IVFEs Ⅷ おわりに 1 IVFEs IVFEs 文献 1 Vanek VW, Seidner DL, Allen P et al. ASPEN position paper clinical role for alternative intravenous fat emulsions. Nutr Clin Pract 250 192, 2012 2 Biesboer AN, Stoehr NA A Product Review of Alternative Oil Based Intravenous Fat Emulsions. Nutr Clin
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