外科肝癌患者的人体组成和能量代谢及其与营养状态的相关性

Human body composition and energy metabolism and their correlations with nutritional status in hepa- tocarcinoma patients undergoing surgical treatment

目的 调查外科肝癌患者的营养状态、人体组成和能量代谢,并分析其相关性.方法因原发性肝癌在北京医院普外科住院拟行手术治疗的患者112例为研究组,同期因胆石症拟接受手术治疗的100例患者为对照组;测量体质量指数、上臂围、握力、外周血白蛋白和前白蛋白等,应用患者提供的主观整体营养评分量表（PG-SGA）评定其营养状态;进行生物电阻抗人体组分测定和间接能量测定;并分析营养状态与人体组成和能量代谢的相关性.结果 与对照组比较,研究组患者的上臂围[（23.9±3.6）cm比（25.3±4.5）cm,t=2.57,P=0.014]、握力[（31.7±6.0）kg比（39.2±7.6）kg,t=8.19,P〈0.001]以及外周血白蛋白[（32.5±4.7）g/L比（36.5±7.2）g/L,t=4.92,P=0.007]和前白蛋白[（0.172±0.052）g/L比（0.263±0.077）g/L,t=10.3,P=0.004]水平均明显降低;研究组总营养不足发生率为37.5％（PG-SGA分级B＋C级42例）,显著多于对照组的14.0％（PG-SGA分级B＋C级14例）（X2=19.73,P〈0.001）;研究组细胞外水含量明显增多[（15.35±2.21）L比（13.51±2.73）L,t=5.54,P〈0.001],脂肪组织[（13.44±4.23）kg比（17.36±5.21）kg,t=6.18,P〈0.001]和肌肉组织量[（43.11±6.27）kg比（48.17±7.13）kg,t=5.63,P〈0.001]显著减低,体细胞群也明显减少[（27.54±4.42）kg比（29.03±4.38）kg,t=2.53,P=0.012];研究组静息能量消耗实际测定值明显增高[（6 581.62±1 201.70）kJ/d比（6 290.73±1 071.68）kJ/d,t=1.98,P=0.042];呼吸商也较高（0.87±0.10比0.85±0.06,t=2.72,P=0.027）,随着营养状态的恶化,细胞外液增加（PG-SGA分级A级比B级P=0.035,A级比C级P=0.001,B级比C级P=0.042）,体细胞数（PG-SGA分级A级比B级P=0.015,A级比C级P=0.001,B级比C级P=0.022）、脂肪（PG-SGA分级A级比B级P=0.026,A级比C级P=0.003,B级比C级P=0.022）和肌肉量（PG-SGA分级A级比B级P=0.029,A级比C级P=0.011,B级比C级P=0.036）减少,静息能量消耗（PG-SGA分级A级比B级P=0.023,A级比C级P=0.002,B级比C级P=0.032）和呼吸商（PG-SGA分级A级比C级P=0.004,B级比C级P=0.012）增高,组间比较差异有统计学意义.结论 外科肝癌患者的营养不良发生率较高,机体存在肌肉减少和水潴留表现,能量代谢较高,并且随营养状态恶化而加重.

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index（BMI）,arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment（PG-SGA）.The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [（23.9±3.6）cm vs.（25.3±4.5）cm,t=2.57,P=0.014],hand grip[（31.7±6.0）kg vs.（39.2±7.6）kg,t=8.19,P〈0.001],serum albumin[（32.5±4.7）g/L vs.（36.5±7.2）g/L,t=4.92,P=0.007] and prealbumin[（0.172±0.052）g/L vs.（0.263±0.077）g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5%（42 cases at levels B and C）,and that of the control group was 14.4%（14 cases at levels B and C）（X2=19.73,P〈0.001）.The extracellular water significantly increased in the intervention group compared with that of the control group[（15.35±2.21）L vs.（13.51±2.73）L,t=5.54,P〈0.001];however,the somatic cell mass [（27.54±4.42）kg vs.（29.03±4.38）kg,t=2.53,P=0.012],fat mass[（13.44±4.23）kg vs.（17.36±5.21）kg,t=6.18,P〈0.001],and muscle mass[（43.11±6.27）kg vs.（48.17±7.13）kg,t=5.63,P〈0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure（mREE）[（6 581.62±1 201.70）kJ/d vs.（6 290.73±1 071.68）kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group（P=0.042）,and the respiratory quotient（RQ）was also significantly higher（0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027）.The extracellular fluid（PG-SGA A vs.B P=0.035;A vs.C P〈0.001;B vs.C P=0.042）were significantly increased,and the number of somatic cells（A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022）,fat（A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022）and muscle mass（A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036）were decreased with the deterioration of nutritional status,resting energy expenditure（A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032）,and RQ（A vs.C P=0.004;B vs.C P=0.012）were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.