CAJ | 학술논문

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MedGraphics 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（ P＜0.05）。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。
목적：탐토만가급성간쇠갈（ ACLF）환자주원기간적동태능량대사상황，위개체화적림상영양지지제공이론의거。방법응용미국MedGraphics CCM／D영양대사측시계통（대사차）측정24례호전적ACLF환자（존활조）급9례사망적ACLF환자（사망조）입원、주원기간、출원／사망시적능량대사지표급생화지표。결과존활조출원시REE／pREE여입원비교차이무통계학의의。사망조주원기간REE／pREE여존활조비교차이유통계학의의（P＝0.008）。입원시량조호흡상（RQ）치、탄수화합물양화솔（CHO％）균편저，차이무통계학의의。존활조출원시RQ치급CHO％균유소상승，여입원시비교차이유통계학의의（ P＜0.05）。사망조사망시RQ치급CHO％균강저，RQ、CHO％여존활조출원시비교차이유통계학의의（ P＝0.006）。 Pearson상관분석현시， REE／pREE여직접담홍소、총담즙산、백세포계수정정상관，여응혈매원활동도정부상관。 RQ、CHO％여응혈매원활동도、총담고순정정상관，여직접담홍소、백세포계수정부상관。결론 ACLF환자치료과정중추우저대사적상태유조우병정회복，유리우개선환자예후；호흡상급삼대영양저물양화비례적변화비정식능량대사경민감，시ACLF영양간예치료중중요적、교호적감측지표；PTA급TC여대사지표변화일치차령민，가간접체현환자적능량대사상태。
Objective To investigate the dynamic energy metabolism in acute -on -chronic liver failure ( ACLF) patients during hospitalization , and to provide a theoretical basis for individualized clinical nutrition support . Methods CCM/D nutrition metabolism investigation system was adopted to measure the energy metabolism indexes and biochemical indexes in 33 HBV-ACLF patients (24 for the survival group, 9 for the death group) at admission, in hospi-talization and at discharge or before death .Results REE/pREE(%) at admission, in hospitalization and at discharge in the survival group were (94.50 ±31.88)%, (90.25 ±23.71)% and (81.04 ±26.88)%, respectively; those in the death group were (113.78 ±17.35)%, (114.00 ±24.42)% and (102.78 ±20.87)%, respectively; while there was significant difference in REE/pREE in hospitalization between the two groups ( P =0.008).At admission, RQ and CHO% in the two groups were low , with no significant difference .At discharge in the survival group , significant increases in RQ (to 0.84 ±0.06) and CHO% [to (43.96 ±20.49)%] were observed compared with those at admission (P=0.025 and 0.008, respectively).Before death in the death group, significant reduction in RQ (to 0.78 ±0.05) and CHO%[(21.56 ±14.66)%] were revealed compared with those at discharge in the survival group (P=0.006).Pear-son correlation analysis showed that REE/pREE(%) was negatively correlated with PTA , while RQ and CHO%were pos-itively correlated with PTA and TC .Conclusion Low metabolism is helpful for improvement of prognosis in ACLF pa-tients.RQ and the substrate oxidation rates are better monitoring indexes than REE .PTA and TC can indirectly reflect the energy metabolism in the patients .