[Laboratory investigation and clinical application of S-adenosyl-L-methionine in the treatment of cholestasis after total parenteral nutrition].
OBJECTIVE
To observe the therapeutic effects of S-Adenosyl-L-methionine(SAMe) in the treatment of cholestasis after total parenteral nutrition (TPN).


METHODS
Thirty SD rats were randomly divided into control group, hypercalorie group, hypercalorie adds SAMe group; sepsis group and sepsis adds SAMe group; their stages of cholestasis were compared. Sixteen patients received SAMe because of cholestasis after prolonged TPN.


RESULTS
Bile flow, serum levels of total bile acid and gamma-glutamyl transpeptidase were elevated markedly in hypercalorie and sepsis groups. Hepatocellular fatty degeneration, dilatation of cholangiole, and bile sludge could be seen microscopically, while SAMe administration in hypercalorie adds SAMe and sepsis adds SAMe groups could increase bile flow, decrease serum total bile acid and gamma-glutamyl transpeptidase levels. Microscopic findings were normal, no dilated cholangiole or bile sludge could be found. Cholestasis and abnormal results of liver function test were the main clinical manifestations of 16 patients before SAMe administration. Three weeks after SAMe administration, their serum levels of total bilirubin, alkaline phosphotase, gamma-glutamyl transpeptidase, alanine aminotransferase(ALT), and aspartate aminotransferase(AST) were decreased markedly; they became normal in the 4 th week.


CONCLUSIONS
SAMe could prevent and treat cholestasis without discontinuation of TPN.
Institute of General Surgery, Nanjing General Hospital of Nanjing Command, People's Liberation Army, Nanjing 210002, China.
Ning
N
Li
Honghai
H
Zhang
Shaohua
S
Wang
Weiming
W
Zhu
Jian'an
J
Ren
Jieshou
J
Li
D000328:Adult; D000818:Animals; D002779:Cholestasis / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012436:S-Adenosylmethionine / Q000627:therapeutic use*
D012436:S-Adenosylmethionine