经颈静脉肝内门体分流术后体重增加与肝硬化和高代谢的营养不良患者身体成分的改善有关。
Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism.
作者信息
Plauth Mathias, Schütz Tatjana, Buckendahl Deborah P, Kreymann Georg, Pirlich Matthias, Grüngreiff Sven, Romaniuk Paul, Ertl Siegfried, Weiss Marie-Luise, Lochs Herbert
机构信息
Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
出版信息
J Hepatol. 2004 Feb;40(2):228-33. doi: 10.1016/j.jhep.2003.10.011.
BACKGROUND/AIMS: To search for changes in body composition and energy metabolism associated with the repeatedly observed weight gain of cirrhotic patients after portosystemic shunting.
METHODS
Twenty-one patients were studied prospectively before and 6 and 12 months after transjugular intrahepatic portosystemic shunt (TIPS) to assess body cell mass by two independent methods (total body potassium counting: body cell mass determined by TBP, BCMTBP, bioelectric impedance analysis: body cell mass determined by BIA, BCMBIA), muscle mass (anthropometry), resting energy expenditure (REECALO) by indirect calorimetry, and nutritional intake by dietary recall analysis.
RESULTS
Prior to TIPS patients were hypermetabolic in terms of measured vs. predicted REE (REECALO median 1423 (range 1164-1838) vs. REEPRED 1279 (1067-1687) kcal; P<0.05) and their body cell mass was lower (19.1 (10.9-33.4) vs. 31.7 (16.8-47.1) kg; P=0.001). After TIPS body cell mass (BCMBIA) increased to 23.5 (12.7-44.3) (P<0.025) and 25.7 (14.2-39.7) kg (P=0.05) at 6 and 12 months after TIPS and this was confirmed by total potassium counting (BCMTBP before TIPS: 18.8 (10.6-26.7) vs. 22.4 (12.9-28.5) kg at 6 months; P<0.01). Hypermetabolism persisted throughout the study period. Energy and protein intake increased significantly by 26 and 33%.
CONCLUSIONS
An increase of prognostically relevant variables body cell and muscle mass contributes to the weight gain after TIPS in malnourished patients with cirrhosis and hypermetabolism.
背景/目的：探寻与门体分流术后肝硬化患者反复出现的体重增加相关的身体成分及能量代谢变化。
方法
对21例患者在经颈静脉肝内门体分流术（TIPS）前、术后6个月及12个月进行前瞻性研究，通过两种独立方法评估身体细胞质量（全身钾计数：通过TBP测定的身体细胞质量，BCMTBP；生物电阻抗分析：通过BIA测定的身体细胞质量，BCMBIA）、肌肉质量（人体测量法）、通过间接测热法测定的静息能量消耗（REECALO）以及通过饮食回顾分析评估的营养摄入情况。
结果
在TIPS术前，患者实测REE与预测REE相比处于高代谢状态（REECALO中位数1423（范围1164 - 1838）与REEPRED 1279（1067 - 1687）千卡；P<0.05），且其身体细胞质量较低（19.1（10.9 - 33.4）与31.7（16.8 - 47.1）千克；P = 0.001）。TIPS术后，在术后6个月和12个月时，身体细胞质量（BCMBIA）分别增加至23.5（12.7 - 44.3）（P<0.025）和25.7（14.2 - 39.7）千克（P = 0.05），全身钾计数也证实了这一点（TIPS术前BCMTBP：18.8（10.6 - 26.7）与术后6个月时的22.4（12.9 - 28.5）千克；P<0.01）。高代谢状态在整个研究期间持续存在。能量和蛋白质摄入量显著增加了26%和33%。
结论
对于营养不良且伴有高代谢的肝硬化患者，TIPS术后具有预后相关性的变量身体细胞和肌肉质量增加导致了体重增加。
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