慢加急性肝衰竭患者的能量代谢状况

发布时间：2018-04-14 21:52

本文选题：慢加急性肝衰竭 + 静息能量消耗　；参考：《广东医学》2015年02期

【摘要】：目的探讨慢加急性肝衰竭(ACLF)患者住院期间的动态能量代谢状况,为个体化的临床营养支持提供理论依据。方法应用美国Med Graphics CCM/D营养代谢测试系统(代谢车)测定24例好转的ACLF患者(存活组)及9例死亡的ACLF患者(死亡组)入院、住院期间、出院/死亡时的能量代谢指标及生化指标。结果存活组出院时REE/pREE与入院比较差异无统计学意义。死亡组住院期间REE/pREE与存活组比较差异有统计学意义(P=0.008)。入院时两组呼吸商(RQ)值、碳水化合物氧化率(CHO%)均偏低,差异无统计学意义。存活组出院时RQ值及CHO%均有所上升,与入院时比较差异有统计学意义(P0.05)。死亡组死亡时RQ值及CHO%均降低,RQ、CHO%与存活组出院时比较差异有统计学意义(P=0.006)。Pearson相关分析显示,REE/pREE与直接胆红素、总胆汁酸、白细胞计数呈正相关,与凝血酶原活动度呈负相关。RQ、CHO%与凝血酶原活动度、总胆固醇呈正相关,与直接胆红素、白细胞计数呈负相关。结论 ACLF患者治疗过程中趋于低代谢的状态有助于病情恢复,有利于改善患者预后;呼吸商及三大营养底物氧化比例的变化比静息能量代谢更敏感,是ACLF营养干预治疗中重要的、较好的监测指标;PTA及TC与代谢指标变化一致且灵敏,可间接体现患者的能量代谢状态。
[Abstract]:Objective to investigate the dynamic energy metabolism in patients with chronic and acute hepatic failure (ACLF) during hospitalization, and to provide theoretical basis for individualized clinical nutritional support.Methods 24 patients with improved ACLF (survival group) and 9 dead ACLF patients (death group) were admitted to hospital and hospitalized by Med Graphics CCM/D nutritional Metabolism Test system (Metabolism vehicle).Energy metabolism and biochemical indexes at discharge / death.Results there was no significant difference in REE/pREE between the survival group and the hospital at discharge.The difference of REE/pREE between the dead group and the survival group was statistically significant.The RQs of respiratory quotient (RQ) and the carbohydrate oxidation rate (CHO) of the two groups were lower than those of the control group at admission, but there was no significant difference between the two groups.The RQ and CHO% increased at the time of discharge in the survival group, and the difference was statistically significant compared with that at admission (P 0.05).The RQ and CHO% in the death group were significantly lower than those in the survival group at discharge. Pearson correlation analysis showed that REE / pREE was positively correlated with direct bilirubin, total bile acid and white blood cell count.There was a negative correlation between prothrombin activity and prothrombin activity, total cholesterol, direct bilirubin and white blood cell count.Conclusion the state of low metabolism in the treatment of ACLF is helpful to the recovery of the disease and to the improvement of prognosis, the changes of respiratory quotient and oxidation ratio of three nutrient substrates are more sensitive than those of resting energy metabolism.It is important in the treatment of ACLF nutrition intervention. The better monitoring indexes, such as ACLF and TC, are consistent with and sensitive to the metabolic indexes, and can indirectly reflect the energy metabolism state of the patients.
【作者单位】：首都医科大学附属北京佑安医院重症肝病科;
【基金】：首都卫生发展科研专项资助项目(编号:首发2011-2018-09) 北京市科技计划重大项目(编号:H020920020890)
【分类号】：R575.3

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