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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;SPSS 11.5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(19.2±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±7.3 kcal·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),(4.1±2.5)kcal·kg~(-1)·d~(-1)]低于消耗量[(5.3±3.7)kcal·kg~(-1)·d~(-1),(6.5±10.0)kcal·kg~(-1)·d~(-1)];静息能量消耗值与 ALT、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。
Objective To explore the characteristics of energy metabolism in patients with chronic severe viral hepatitis (chronic severe hepatitis) to guide the clinical early and active nutritional supportive treatment of chronic severe hepatitis and improve the survival rate of patients. Methods The resting energy expenditure (REE) level in 55 patients with early-mid-chronic liver disease was measured by indirect calorimetry and compared with the predicted value calculated by the Harris-Benedict formula (HB formula). Patients were analyzed by diet nutrition expert software system Diet structure, and analyze the correlation between energy consumption and main liver function indexes (ALT, AST, TBiL, PTA); SPSS 11.5 software statistical processing. Results The results of REE (20.7 ± 6.0) kcal · kg -1 · d -1 lower than those predicted by HB formula (22.1 ± 2.2) kcal Kg · d -1 · d -1 (P <0.01); REE (19.2 ± 6.1) kcal · kg -1 · d ~ (-1), lower than the predicted value of HB formula (23.1 ± 2.3) kcal · kg -1 (-1) · d -1 (P <0.01); carbohydrate intake ) kcal · kg -1 · d -1 was significantly higher than that of the control group (7.9 ± 7.3 kcal · kg -1 -1 · d -1) (P <0.01) The intake of [(3.4 ± 1.6) kcal · kg -1 · d -1, (4.1 ± 2.5) kcal · kg -1 · d -1] was lower than the consumption [(5.3 ± 3.7) kcal · kg -1 · d -1, (6.5 ± 10.0) kcal · kg -1 · d -1]. The resting energy expenditure and (R = -0.284, P <0.05). There was a negative correlation between serum total protein and protein oxidation (r = -0.284, P <0.05) (R = 0.362, P <0.01; r = 0.348, P <0.01). There was a negative correlation between serum cholesterol and fat oxidation (r = -0.328, P <0.05), and there was a significant positive correlation with the oxidation of carbohydrates and Breathing business (R = 0.338, P <0.05; r = 0.354, P <0.01). There was a negative correlation between serum triglyceride and protein oxidation (r = 0.387, P <0.05) Low metabolism; the consumption of three nutrients was mainly carbohydrates, but the proportion of protein consumption increased significantly, the body was negative nitrogen balance; ALT, TBil, PTA and resting energy consumption was not significantly correlated with blood glucose, Total protein, cholesterol, and triglycerides were all associated with increased use of glucose in the body, potentially reducing body fat and protein consumption.