Avesani C M, Cuppari L, Silva A C, Sigulem D M, Cendoroglo M, Sesso R, Draibe S A
Division of Nephrology, Federal Univertsity of São Paulo, UNIFESP, São Paulo, Brazil.
Nephrol Dial Transplant. 2001 Mar;16(3):556-65. doi: 10.1093/ndt/16.3.556.
The metabolic derangements of diabetes mellitus (DM) associated with those of chronic renal failure (CRF) may interfere with the energy and protein balance of patients with both diseases. The aim of this study was to verify whether the resting energy expenditure (REE) of non-dialysis chronic renal failure diabetic patients differs from that of chronic renal failure patients without DM.
REE was measured by indirect calorimetry in 24 CRF diabetic patients (CRF diabetes group), matched for age, gender, and degree of renal impairment to 24 CRF patients without DM (CRF control group).
The CRF diabetes group had a significantly higher REE (1538+/-230 kcal/day) than the CRF control group (1339+/-315 kcal/day, P = 0.009). This difference was maintained even when the REE was adjusted for lean body mass (LBM; 30.3+/-4.3 vs 26.3+/-5.4 kcal/kg LBM/day, P = 0.004). Mean protein intake was significantly higher in the CRF diabetes than in the CRF control group (0.89+/-0.20 vs 0.76+/-0.25 g/kg/day, P = 0.02). Mean protein equivalent of nitrogen appearance (PNA) was also significantly higher in the CRF diabetes patients (1.21+/-0.31 vs 1.03+/-0.22 g/kg/day, P = 0.02), reflecting a higher protein intake and/or elevated protein breakdown. Accordingly, REE was directly correlated with PNA mainly in the CRF diabetes group (r = 0.57, P < 0.003).
Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.
糖尿病（DM）的代谢紊乱与慢性肾衰竭（CRF）的代谢紊乱可能会干扰这两种疾病患者的能量和蛋白质平衡。本研究的目的是验证非透析慢性肾衰竭糖尿病患者的静息能量消耗（REE）是否与无糖尿病的慢性肾衰竭患者不同。
通过间接测热法测量24例CRF糖尿病患者（CRF糖尿病组）的REE，这些患者在年龄、性别和肾功能损害程度上与24例无糖尿病的CRF患者（CRF对照组）相匹配。
CRF糖尿病组的REE（1538±230千卡/天）显著高于CRF对照组（1339±315千卡/天，P = 0.009）。即使在根据瘦体重（LBM）调整REE后，这种差异仍然存在（30.3±4.3与26.3±5.4千卡/千克LBM/天，P = 0.004）。CRF糖尿病组的平均蛋白质摄入量显著高于CRF对照组（0.89±0.20与0.76±0.25克/千克/天，P = 0.02）。CRF糖尿病患者的平均蛋白质氮出现量（PNA）也显著更高（1.21±0.31与1.03±0.22克/千克/天，P = 0.02），这反映了更高的蛋白质摄入量和/或蛋白质分解增加。因此，REE主要在CRF糖尿病组中与PNA直接相关（r = 0.57，P < 0.003）。
控制不佳的DM的代谢紊乱可能是CRF糖尿病组中观察到的较高REE的原因。这种增加的REE中明显较高的蛋白质分解的作用仍有待阐明。
