慢性重型病毒性肝炎患者的能量代谢特点及相关性研究

目的探讨慢性重型病毒性肝炎（慢重肝）患者的能量代谢特点,以指导慢重肝的临床早期、积极营养支持治疗,提高患者存活率。方法采用间接测热法测试55例慢重肝早中期患者的静息能量消耗（REE）水平,并与Harris-Benedict公式（HB公式）计算的预计值进行比较;通过膳食营养专家软件系统分析患者饮食结构,并对能量消耗与肝脏主要功能指标（ALT、AST、TBiL、PTA）的相关性进行分析;SPSS11、5软件统计处理。结果慢重肝早中期患者（慢性肝炎为基础）REE实测值（20、7±6、0）kcal·kg^-1·d^-1低于HB公式计算的预计值（22.1±2、2）kcal·kg^-1·d^-1（P〈0．01）;慢重肝早中期患者（肝硬化为基础）REE实测值（19、24-6、1）kcal·kg^-1·d^-1,低于HB公式计算的预计值（23．1±2、3）kcal·kg^-1·d^-1（P〈0．01）;碳水化合物的摄入量（21、6±7、4）kcal·kg^-1·d^-1明显大于其消耗量（7、9±7、3kcal·kg^-1·d^-1。（P〈0、01）,蛋白质、脂肪的摄入量（3、4±1、6）kcal·kg^-1·d^-1,（4．14_2、5）kcal·kg^-1·d^-1。]低于消耗量（5、34-3、7）kcal·kg^-1·d^-1,（6、54-10．0）kcal·kg^-1·d^-1。];静息能量消耗值与AlJT、TBil、PTA无明显相关性;血糖与脂肪氧化呈正相关（r=0、310,P〈0、05）;血清总蛋白水平与蛋白质的氧化呈负相关（r=-0、284,P〈0．05）,与碳水化合物的氧化及呼吸商呈正相关（r=0、362,P〈0、01;r=0、348,P〈0、01）;血清胆固醇与脂肪氧化呈负相关（r=-0、328,P〈0．05）,与碳水化合物氧化及呼吸商呈正相关（r=0、338,P〈0．05;r=0、354,P〈0、01）;血清甘油三酯与蛋白质的氧化呈负相关（r=-0．387,P〈0．05）。结论慢重肝患者静息能量呈低代谢状态;三大营养物的消耗以碳水化合物为主,但比例分配蛋白质的消耗明显增加,机体呈负氮平衡;ALT、TBil、PTA与静息能量的消耗无明显相关性,与血糖、总蛋白、胆固醇、甘油三酯均存在相关性。提高机体对葡萄糖的有效利用,有可能降低机体对脂肪和蛋白质的消耗。

Energy metabolism in patients with severe chronic viral hepatitis

OBJECTIVE: To evaluate the pattern of energy metabolism of patients with chronic viral severe hepatitis. METHODS: Resting energy expenditure (REE) in 55 patients with chronic viral severe was measured with open-circuit indirect calorimetry. Their normal REE was predicted by Harris-Benedict equation (HBE). The patients were to eat the ordinary diet from the department of nutrition of the hospital. The diet was recorded for 3 days. RESULTS: The REE value of the patients with chronic viral severe hepatitis based on cirrhosis was 19.2 +/- 6.1 kcal.kg(-1).d(-1), significantly lower than the normal predicted REE (22.1 +/- 2.2 kcal.kg(-1).d(-1), P < 0.01). The REE value of the patients with chronic viral severe hepatitis based on chronic hepatitis was 20.7 +/- 6.0 kcal.kg(-1).d(-1), significantly lower than the normal predicted REE (23.1 +/- 2.3 kcal.kg(-1).d(-1), P < 0.05). The intake of carbohydrates was 21.6 +/- 7.4 kcal.kg(-1).d(-1), significantly higher than oxidation amount (7.9 +/- 7.3 kcal.kg(-1).d(-1), P < 0.01). While the intake values of fat and protein were 3.4 +/- 1.6 kcal.kg(-1).d(-1) and 4.1 +/- 2.5 kcal.kg(-1).d(-1), both lower than the needed amounts. There was no significant correlation between energy metabolism and liver function. There was a positive correlation between glucose in serum and fat oxidation (r = 0.310, P < 0.05). The serum total protein (TP) level was positively correlated with carbohydrate oxidation (r = 0.362, P < 0.01) and RQ (r = 0.348, P < 0.01); The serum cholesterol level was positively correlated with carbohydrate oxidation (r = 0.338, P < 0.05) and RQ (r = 0.354, P < 0.01). The protein oxidation was negatively correlated with serum TP (r = -0.284, P < 0.05), and serum triglyceride (TG) (r = -0.387, P < 0.05). Fat oxidation was negatively correlated with cholesterol (r = -0.328, P < 0.05). CONCLUSION: Hypometablosim is found in severe chronic hepatitis. There is no significant correlation between energy metabolism and liver function. There is certain correlation between energy metabolism and some parameters in serum, such as glucose, TP, cholesterol, and TG. It may decrease the oxidation of fat and protein to increase the oxidation of carbohydrates.