摘要
目的探讨酒精性慢加亚急性肝衰竭患者(酒精肝衰竭组)的能量代谢与临床特点。方法选择28例酒精肝衰竭患者为研究组,48例乙肝慢加亚急性肝衰竭患者(乙肝肝衰竭组)为对照组,根据疾病程度分早期和中期,根据预后分恢复和死亡。应用间接能量代谢测定仪及24h尿素氮测定患者静息能量消耗(resting energy expenditure,REE)、呼吸商(respiratory quotient,RQ)、碳水化合物(carbohydrate,CHO)、蛋白质(protein,PRO)和脂肪(FAT)的氧化率。结果酒精肝衰竭组RQ值显著低于乙肝肝衰竭组[(0.80±0.06)vs.(0.84±0.05),P=0.007]。同为疾病中期或死亡组,酒精肝衰竭组RQ值显著低于乙肝组[(0.78±0.05)vs.(0.83±0.05),(0.75±0.04)vs.(0.82±0.05),P均=0.001]。酒精肝衰竭组内,中期患者RQ显著低于早期[(0.78±0.05)vs.(0.83±0.05),P=0.007],死亡组RQ及CHO氧化率显著低于恢复组[(0.75±0.04)vs.(0.83±0.04),P=0.000;(25.82±13.04)%vs.(38.41±14.69)%,P=0.029],而FAT氧化率显著增高[(54.55±11.44)%vs.(40.29±14.53)%,P=0.011]。结论酒精肝衰竭患者REE与乙肝肝衰竭患者相似,均以FAT氧化供能为主、伴CHO利用障碍为代谢特点,并且随病情动态变化的趋势是一致的;酒精肝衰竭患者RQ值降低更加显著,RQ值与疾病严重程度和预后密切相关。合理的营养支持可降低营养不良的发生,改善预后。
Objective To investigate the energy metabolism and clinical features in patients with sub-acute-on-chronic alcoholic liver failure. Methods 76 patients with sub-acute-on-chronic fiver failure were selected and divided into 2 groups： study group with 28 alcoholic liver failure patients （ASCLF） and control group with 48 hepatitis B patients （HSCLF）. Then they were further divided into early and middle stages by disease progression, and recovery and death subgroups by prognosis. Resting energy expenditure （REE）, respiratory quotient （RQ） and oxidation rate of carbohydrate （CHO）, fat （FAT）, protein （PRO） were evaluated by indirect calori-metry （IC） and 24-hour urea nitrogen. Results RQ of ASCLF was significantly lower than that of HSCLF [（0.80＋0.06） vs. （0.84±0.05）, P = 0.007）. In middle stage or death group, RQ value of ASCLF was still significantly lower than HSCLF [（0.78±0.05）vs. （0.83±0.05）; （0.75±0.04） vs. （0.82±0.05）; both P = 0.001）]. RQ value in middle stage of ASCLF was significantly lower than in early stage [（0.78± 0.05） vs.（0.83±0.05）, P = 0.007] and in death group it was significantly lower than in recovery group[（0.75±0.04） vs. （0.83± 0.04）, P = 0.000）]; FAT oxidation rate in death group was significantly higher than in recovery group [（54.55±11.44）% vs. （40.29±14.53）%, P = 0.011], while CHO oxidation rate was significantly lower than in recovery group [（25.82±13.04）% vs. （38.41±14.69）%, P = 0.029]. Conclusion REE in patients with ASCLF and HSCLF are similar, where FAT is used as the primary energy supply and CHO metabolism is abnormal. The trends of dynamic REE changes along with the course of disease are also consistent in two groups. RQ value in patients with ASCLF is lower. RQ value decreases more sharply in the serious phase of disease or death group, indicating that RQ is tightly related with prognosis.
出处
《北京医学》
CAS
2011年第12期970-973,共4页
Beijing Medical Journal
基金
国家"十一五"重大专项(2008ZX10002-005-3)
北京市病毒性肝炎重大科技项目(H020920020890)
关键词
酒精
肝衰竭
呼吸商
静息能量消耗
预后
Alcohol Liver failure Respiratory quotient （RQ） Resting energy expenditure （REE） Prognosis
