选择性抗生素治疗对囊性纤维化患者静息能量消耗及炎症的影响。

Effect of elective antibiotic therapy on resting energy expenditure and inflammation in cystic fibrosis.

作者信息

Burdet L, Hugli O, Aubert J D, Schutz Y, Roulet M, Fitting J W

机构信息

Division de pneumologie, Département de médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

出版信息

Eur J Pediatr. 1999 Sep;158(9):711-6. doi: 10.1007/s004310051185.

DOI:10.1007/s004310051185

PMID:10485301

Abstract

Cystic fibrosis (CF) patients often present with malnutrition which may partly be due to increased resting energy expenditure (REE) secondary to inflammation. Both REE and tumour necrosis factor-alpha (TNF-alpha), as other markers of inflammation, are elevated during respiratory exacerbations and decrease after antibiotic treatment. However, the effect of antibiotic therapy on REE and inflammation in patients without respiratory exacerbation is not known. The aim of our study was to determine the effect of such an elective antibiotic therapy on REE, TNF-alpha, and other serum markers of inflammation. Twelve CF patients 5F/7M, age 15.9 +/- 6.1 years, weight for height ratio 89 +/- 8% without clinically obvious exacerbation and treated by intravenous antibiotics were studied. Both before (D0) and after (D14) treatment, pulmonary function tests were performed. REE was measured by indirect calorimetry and blood taken to measure inflammation parameters. Body weight increased by 1.1 kg from D0 to D14 (P < 0.001), composed of 0.3 kg fat mass and 0.8 kg fat-free mass (FFM). The forced expiratory volume at 1 s increased from 43 +/- 15% of predicted at D0 to 51 +/- 15% of predicted at D14 (P < 0.01). Mean REE was 41.1 +/- 7.6 kcal/kg FFM per day at D0 and did not change significantly at D14 (40.6 +/- 8.5 kcal/kg FFM per day). Serum markers of inflammation decreased from D0 to D14: C-reactive protein 17 +/- 17 mg/l to 4 +/- 7 mg/l (P < 0.05), elastase 62 +/- 29 microg/l to 45 +/- 18 microg/l (P < 0.02), orosomucoid acid 1.25 +/- 0.11 g/l to 0.80 +/- 0.15 g/l (P < 0.001), and TNF-alpha 37 +/- 14 pg/ml to 29 +/- 6 pg/ml (P = 0.05). Individual values showed a correlation between changes in REE and in TNF-alpha (P < 0.02). The contribution of inflammation to energy expenditure is possible but appears to be minimal in cystic fibrosis patients treated by antibiotics on a regular basis in the absence of clinically obvious exacerbation.

摘要

囊性纤维化（CF）患者常伴有营养不良，部分原因可能是炎症继发静息能量消耗（REE）增加。REE和肿瘤坏死因子-α（TNF-α）作为炎症的其他标志物，在呼吸加重期升高，抗生素治疗后降低。然而，抗生素治疗对无呼吸加重的患者REE和炎症的影响尚不清楚。我们研究的目的是确定这种选择性抗生素治疗对REE、TNF-α和其他炎症血清标志物的影响。研究了12例CF患者（5例女性/7例男性），年龄15.9±6.1岁，身高体重比89±8%，无明显临床加重，接受静脉抗生素治疗。在治疗前（D0）和治疗后（D14）均进行了肺功能测试。通过间接测热法测量REE，并采集血液测量炎症参数。体重从D0到D14增加了1.1kg（P<0.001），其中脂肪量增加0.3kg，去脂体重（FFM）增加0.8kg。第1秒用力呼气量从D0时预测值的43±15%增加到D14时预测值的51±15%（P<0.01）。D0时平均REE为41.1±7.6kcal/kg FFM/天，D14时无显著变化（40.6±8.5kcal/kg FFM/天）。炎症血清标志物从D0到D14降低：C反应蛋白从17±17mg/L降至4±7mg/L（P<0.05），弹性蛋白酶从62±29μg/L降至45±18μg/L（P<0.02），类粘蛋白酸从1.25±0.11g/L降至0.80±0.15g/L（P<0.001），TNF-α从37±14pg/ml降至29±6pg/ml（P=0.05）。个体值显示REE变化与TNF-α变化之间存在相关性（P<0.02）。在无明显临床加重的情况下，定期接受抗生素治疗的囊性纤维化患者中，炎症对能量消耗的影响是可能的，但似乎很小。