CAJ | 학술논문

目的：研究慢性丙型肝炎（CHC）患者能量代谢特点，为临床营养干预治疗提供依据。方法选取首都医科大学附属北京佑安医院2004年12月－2014年9月收治的70例 CHC 患者及30例健康对照（HC）者为研究对象，应用代谢车进行能量代谢指标测定，包括静息能量消耗（REE）、预测 REE（pREE）、呼吸商（RQ），以及碳水化合物氧化率（CHO％）、脂肪氧化率（FAT％）和蛋白质氧化率（PRO％）。计数资料采用χ2检验，计量资料两组比较采用独立样本 t 检验，三组比较采用单因素方差分析。结果CHC组 REE、REE ／pREE（％）分别为（1360．46±467．55）kcal／d、（99．07±32．92）％，与 HC 组比较差异均无统计学意义（P 值分别为0．169、0．660）。CHC 组 RQ、CHO％分别为0．82±0．06、（35．80±19．56）％，低于 HC 组（P 值均为0．000）。CHC 组 FAT％、PRO％分别为（46．64±22．76）％、（17．56±8．80）％，高于 HC 组（P 值分别为0．011、0．000）。CHC 轻度、中度、重度组 REE ／pREE（％）分为（93．47±26．57）％、（105．42±37．88）％、（116．09±46．24）％，3组比较差异无统计学意义（P ＝0．092）；RQ 分别为0．84±0．06、0．81±0．06、0．78±0．05，3组比较差异有统计学意义（P ＝0．001）。不同基因分型肝损伤程度差异无统计学意义（P ＝0．312），1b 基因型组 RQ 为0．81±0．06、低于非1b 基因型组0．85±0．06，差异有统计学意义（P ＝0．010）。结论CHC 患者 REE 总体呈正常代谢状态，随着肝损伤程度加重，REE 增加；CHC 患者存在营养物质代谢障碍，以 FAT％及 PRO％上升，CHO％降低为主，与肝功能损伤程度及基因分型有一定相关性。
목적：연구만성병형간염（CHC）환자능량대사특점，위림상영양간예치료제공의거。방법선취수도의과대학부속북경우안의원2004년12월－2014년9월수치적70례 CHC 환자급30례건강대조（HC）자위연구대상，응용대사차진행능량대사지표측정，포괄정식능량소모（REE）、예측 REE（pREE）、호흡상（RQ），이급탄수화합물양화솔（CHO％）、지방양화솔（FAT％）화단백질양화솔（PRO％）。계수자료채용χ2검험，계량자료량조비교채용독립양본 t 검험，삼조비교채용단인소방차분석。결과CHC조 REE、REE ／pREE（％）분별위（1360．46±467．55）kcal／d、（99．07±32．92）％，여 HC 조비교차이균무통계학의의（P 치분별위0．169、0．660）。CHC 조 RQ、CHO％분별위0．82±0．06、（35．80±19．56）％，저우 HC 조（P 치균위0．000）。CHC 조 FAT％、PRO％분별위（46．64±22．76）％、（17．56±8．80）％，고우 HC 조（P 치분별위0．011、0．000）。CHC 경도、중도、중도조 REE ／pREE（％）분위（93．47±26．57）％、（105．42±37．88）％、（116．09±46．24）％，3조비교차이무통계학의의（P ＝0．092）；RQ 분별위0．84±0．06、0．81±0．06、0．78±0．05，3조비교차이유통계학의의（P ＝0．001）。불동기인분형간손상정도차이무통계학의의（P ＝0．312），1b 기인형조 RQ 위0．81±0．06、저우비1b 기인형조0．85±0．06，차이유통계학의의（P ＝0．010）。결론CHC 환자 REE 총체정정상대사상태，수착간손상정도가중，REE 증가；CHC 환자존재영양물질대사장애，이 FAT％급 PRO％상승，CHO％강저위주，여간공능손상정도급기인분형유일정상관성。
Objective To characterize the energy metabolism in patients with chronic hepatitis C (CHC)and to provide a basis for clinical nutrition intervention.Methods This study included 70 cases of chronic hepatitis C (CHC)admitted to Beijing YouAn Hospital affiliated to Capital Medical University from December 2004 to September 2014,as well as 30 healthy controls (HCs).Energy metabolism indices were measured with the critical care management system,including resting energy expenditure (REE),predicted resting energy expenditure (pREE),respiratory quotient (RQ)and carbohydrate oxidation rate (CHO%),fat oxidation rate (FAT%),and protein oxidation rate (PRO%).Comparison of categorical data was made by chi -square test;for continuous data,comparison between two groups was made by independent -samples t test,while comparison between three groups by one -way analysis of variance.Results REE and REE /pREE (%)in the patients with CHC were 1360.46 ±467.55 kcal/d and 99.07% ±32.92%,respectively,without significant differences com-pared with those in HCs (P =0.169;P =0.660).RQ of 0.82 ±0.06 and CHO% of 35.80% ±19.56% in CHC patients were lower than those in HCs.(P =0.000;P =0.000).FAT% and PRO% in the participants with CHC were 46.64% ±22.76% and 17.56% ± 8.80%,respectively,significantly higher than those in HCs (P =0.011;P =0.000).REE /pREE (%)in the CHC patients with mild, moderate,and severe liver injury was 93.47% ±26.57%,105.42% ±37.88%,and 116.09% ±46.24%,respectively;there were no significant differences across the three groups (P =0.092).For the three groups,RQ was 0.84 ±0.06,0.81 ±0.06,and 0.78 ±0.05, respectively,and differed significantly (P =0.001).There were no significant differences in the severity of liver injury between patients with different genotypes (P =0.312).RQ was 0.81 ±0.06 for CHC patients with 1b genotype versus 0.85 ±0.06 for non -1b genotypes (P =0.010).Conclusion Generally,CHC patients show a normal metabolic state.REE ascends with increasing severity of liver injury. CHC patients have metabolic disorders of nutrients with increased FAT% and PRO% and decreased CHO%,which may be related to the se-verity of liver injury and genotype to some extent.