慢性肝炎和肝炎后肝硬化患者能量代谢的研究

Energy metabolism in patients with chronic viral hepatitis and posthepatitic cirrhosis

目的了解慢性肝炎(慢肝)与肝炎后肝硬化(肝硬化)患者的物质能量代谢与摄入特点,以有效指导营养治疗。方法采用间接测热法对60例慢肝(慢肝组)和60例肌硬化患者(肝硬化组)的静息能量消耗水平进行测定,分别与 Harris-Benedict 公式计算的基础能量消耗和膳食调查计算的食物能量摄入进行比较;分析静息能量消耗与营养评价指标的相关性。结果肝硬化组的静息能量消耗(77±21)kJ·kg^(-1)·d^(-1),低于基础能量消耗(95±16)kJ·kg^(-1)·d^(-1)(t==-6.49,P<0.01),能量摄入(102±33)kJ·kg^(-1)·d^(-1),是静息能量消耗的1.42±0.61倍,其中蛋白质摄入(0.84±0.31)g·kg^(-1)·d^(-1),是静息蛋白质消耗[(1.11±0.42)g·kg^(-1)·d^(-1)]的0.85±0.52倍,呈负氮平衡(-6.29±4.62);慢肝组的静息能量消耗[(93±18)kJ·kg^(-1)·d^(-1)]与基础能量消耗[(98±8)kJ·kg^(-1)·d^(-1)]比较,差异无统计学意义(P>0.05),能量摄入为(127±34)kJ·kg^(-1)·d^(-1),是静息能量消耗的1.41±0.43倍,其中蛋白质摄入(1.02±0.29)g·kg^(-1)·d^(-1),是静息蛋白质消耗(0.87±0.34)g·kg^(-1)·d^(-1)的1.31±0.61倍,呈负氮平衡(-2.02±4.07);与慢肝组比较,肝硬化组的静息能量消耗、能量及三大能量营养素摄入量、血清白蛋白和前白蛋白水平均显著低下(P<0.01),体重下降明显(P<0.01),负氮平衡严重(P<0.01);肝硬化组的能量摄入与静息能量消耗和基础能量消耗的比值呈正相关(P<0.05),血清前白蛋白与蛋白质氧化率呈负相关(P<0.05)。结论肝硬化患者的静息能量消耗呈低代谢状态;负氮平衡是慢肝与肝硬化患者的共同营养问题;早期预防慢性肝病患者的营养不良能够改善其远期预后。

Objective To evaluate the pattern of energy metabolism and nutrients intake in patients with chronic viral hepatitis and posthepatitic cirrhosis to effectively direct their nutrition therapy. Methods Resting energy expenditure （REE） was measured with open-circuit indirect Jorimetry in 60 patients with chronic viral hepatitis and 60 patients with posthepatitic cirrhosis. Their normal basal energy expenditure （BEE） was predicted by Harris-Benedict equation and energy intake （EI） was determined by diet recall. Correlation between REE and indicators for nutrition assessment was analyzed. Results REE was （77 ± 21 ） kJ · kg^ - 1 . d^ -1 in 60 patients with posthepatitic cirrhosis, significantly lower than BEE [ （95 ± 16） kJ· kg^-1· d^-1（P〈0.01）, and their EI was （102 ±33） kJ · kg^-1 · d^-1, 1.42 ±0.61 times as REE, in which protein intake （PROI） was （0. 84 ±0.31） g · kg^-1· d^-1, 0. 85 ±0.52 times as resting protein expenditure （PROE） [ （1.11 ±0. 42） g · kg^-1· d^-1 ], indicating a negative nitrogen balance （ -6. 29± 4. 62）. In patients with chronic viral hepatitis, REE was （93 ±18） kJ · kg^-1· d^-1, as compared to BEE of（98_＋8） kJ· kg^-1·d^-1,P〉0.05, and theirEIwas（127±34） kJ.kg^-1 · d^-1 ,1. 41± 0. 43 times as REE, inwhich PROI was （1.02 ±0.29） g·kg^-1 · d^-1, 1.31 ±0.61 times as PROE （0.87 ±0.34） g · kg^-1 · d^-1, also indicating a negative nitrogen balance （ -2. 02±4. 07）. REE, EI and intake of three nutrients, serum level of albumin and prealbumin （PA） and body weight significantly decreased in patients with posthepatitic cirrhosis, as compared to those in patients with chronic viral hepatitis （ P 〈 0. 01 ） , indicating a severely negative nitrogen balance （P 〈 0. 01 ）. In patients with posthepatitic cirrhosis, their EI positively correlated to REFJBEE （P 〈 0. 05 ）, and PA reversely correlated to protein oxidation rate （P 〈 0. 05）. Conclusions Hypometablosim of energy was found in patients with posthepatitic cirrhosis. Negative nitrogen balance was a common issue in patients with posthepatitic cirrhosis and chronic viral hepatitis. Early prevention of malnutrition in patients with chronic liver diseases could improve their prognosis in long term.