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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 understand the energy metabolism and ingestion characteristics of patients with chronic hepatitis (chronic liver disease) and posthepatitic cirrhosis (cirrhosis) to effectively guide nutrition therapy. Methods Indirect calorimetry was used to measure resting energy expenditure in 60 patients with chronic liver disease (chronic liver disease group) and 60 patients with cirrhosis (cirrhosis group). The energy consumption and dietary survey were calculated respectively according to the Harris-Benedict formula Calculated food energy intake were compared; analysis of resting energy expenditure and nutritional evaluation of the correlation. Results The resting energy expenditure of patients with cirrhosis was (77 ± 21) kJ · kg -1 · d -1, lower than 95 ± 16 kJ · kg -1 d ~ (-1) (t == - 6.49, P <0.01), and energy intake (102 ± 33) kJ · kg -1 · d -1 was 1.42 ± 0.61 (0.84 ± 0.31) g · kg -1 · d -1, which is the resting protein consumption [(1.11 ± 0.42) g · kg -1 · d -1 -1)], which was 0.85 ± 0.52 times of negative nitrogen balance (-6.29 ± 4.62). Resting energy expenditure of [93 ± 18] kJ · kg -1 (-1) ] And basic energy expenditure [(98 ± 8) kJ · kg -1 · d -1], the difference was not statistically significant (P> 0.05), and the energy intake was (127 ± 34) kJ · Kg -1 · d -1, which was 1.41 ± 0.43 times of the rest energy consumption, and the protein intake was (1.02 ± 0.29) g · kg -1 · d -1 , Which was 1.31 ± 0.61 times of resting protein consumption (0.87 ± 0.34) g · kg -1 · d -1, with negative nitrogen balance (-2.02 ± 4.07). Compared with chronic liver group, Resting energy expenditure, energy and intake of three major energy nutrients, serum albumin and prealbumin levels were significantly lower (P <0.01), weight loss significantly (P <0.01), and negative nitrogen balance (P <0.01); energy intake and rest in cirrhosis group It was consumed and the amount of energy consumption basis the ratio of positive correlation (P <0.05), albumin and protein oxidation rate was negatively correlated (P <0.05) serum. Conclusion Resting energy expenditure in patients with liver cirrhosis is in a low metabolic state. Negative nitrogen balance is a common nutritional problem in patients with chronic liver disease and liver cirrhosis. Early prevention of malnutrition in patients with chronic liver disease can improve its long-term prognosis.