摘要
目的探讨慢性重型乙型肝炎患者的静息能量消耗(REE)及糖、脂肪、蛋白质营养物质的氧化率,了解慢性重型乙型肝炎患者物质、能量代谢的特点。方法以56例慢性重型乙型肝炎患者(慢重肝组)为研究对象,16例急性乙型肝炎患者作为对照(急性肝炎组),采用间接测热法应用CCMD营养代谢测试系统检测患者的REE及糖、脂肪、蛋白质营养物质的氧化率。结果慢重肝患者的REE为(5831.7±1404.9)kJ/d,低于正常预计值(preREE)(6565.9±1392.7)kJ/d(P=0.001),仅为预测值的(90.5±22.2)%。慢重肝组每公斤体重静息能量消耗(REE/kg)为(86.9±25.6)kJ·d1·kg1,明显低于急性肝炎组的(108.4±47.5)kJ·d1·kg1(P<0.05)。慢重肝组的呼吸商(RQ)为0.84±0.06,亦低于急性肝炎组的0.90±0.05(P=0.000)。慢重肝组碳水化合物的氧化率为39.2%,明显低于急性肝炎组的58.1%(P<0.05),而脂肪氧化率达39.8%,明显高于急性肝炎组的20.2%(P<0.05)。慢重肝组中病情处于早、中、晚期患者的能量及物质代谢差异无显著性。慢重肝组患者肝功能改善后,REE无明显变化,RQ值有升高趋势,碳水化合物氧化率升高,脂肪氧化率降低,但差异无显著性(P>0.05)。结论慢重肝患者处于低能量代谢状态,对糖类利用存在障碍,只能通过加强脂肪动员供能。随着肝功能恢复,患者体内对糖类利用增加,RQ值上升可作为病情恢复的标志。
Objective To evaluate the pattern of energy expenditure and the oxidation rates of carbohydrates, fats, and protein in patients with severe chronic haptitis B. Methods Seventy two patients with hepatitits B virus infection were divided into 2 groups： 56 patients with severe chronic hepatitis （SCH group） and 16 patients with acute hepatitis （ AH group）. Resting energy expenditure （REE） and substrate oxidation was evaluated by indirect calorimetry （IC）. Results REE was （5 831.7 ± 1 404. 9 ） kJ/d in SCH group, which was significandy decreased compared with normal predicted REE （P = 0. 001 ）. The daily REE in SCH group [ （ 86.9 ±25.6 ） kJ ·d^-1·kg^-1 was significantly lower than that in AH group [ （ 108.4 ± 47.5 ） kJ ·d^-1·kg^-1 （P 〈0.05 ）. Similarly, the respiratory quotient （RQ） in SCH group （0.84 ± 0.06 ） was significantly lower than that in AH group （0. 90 ±0.05 ） （ P 〈 0.05 ）. The oxidation rate of carbohydrate in SCH group （39.2%）was significantly lower than that in acute hepatitis group （58.1% ） （P 〈 0. 05 ）. However, the oxidation rate of fat was 39.8% in chronic severe hepatitis group, which was significantly higher than that in acute hepatitis group （20.2%） （P 〈0.05 ）. Energy metabolism and substrate oxidation were not statistically different among different stages of severe chronic viral hepatitis. After the patients＇s liver functions were improved after treatment, REE had no obvious changes, while respiratory quotient （RQ） showed a trend to increase, accompanied by reduced lipid oxidation and enhanced carbohydrate oxidation; however, all these changes was not significantly different （P 〉 0.05 ）. Conclusions Hypometabolism exists in patients with severe chronic hepatitis. Disorder in utilizing carbohydrate results in excess utilization of fat to produce energy. Along with the recovery of liver functions, the utilization of carbohydrate increases. Elevation of RQ value may be a useful sign of recovery.
出处
《中国临床营养杂志》
2006年第2期110-114,共5页
Chinese Journal of Clinical Nutrition
基金
国家重点科技项目(969203720)
北京市科技项目(H010210110129)
关键词
病毒性肝炎
能量代谢
呼吸商
静息能量消耗
viral hepatitis
energy metabolism
respiratory quotient
resting energy expenditure
