酒精性肝衰竭患者能量代谢与临床特点

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 expendi...

Energy metabolism and clinical features of patients with sub-acute-on-chronic alcoholic liver failure

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 liver 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.