Thörne A, Johansson U, Wahren J, Eriksson S
Department of Surgery, Huddinge University Hospital, Sweden.
J Hepatol. 1992 Sep;16(1-2):145-52. doi: 10.1016/s0168-8278(05)80107-2.
Energy expenditure was determined using continuous indirect calorimetry in the basal state and during 3 h of total parenteral nutrition (TPN) in 8 patients with cirrhosis and 8 healthy volunteers. TPN consisted of glucose, fat and amino acids and had a glucose/fat ratio of 50:50. The infusion rate was set to provide energy corresponding to 62.5% of the individually measured 24-h resting energy expenditure. In the basal state energy expenditure was similar in patients and controls while the respiratory quotient (RQ) was lower in the patients (0.78 +/- 0.01 vs. 0.82 +/- 0.01, mean +/- SEM, p < 0.05). During TPN, energy expenditure increased progressively during the 3-h infusion period. The average rise in energy expenditure was similar in patients (19.1 +/- 1.2%) and in controls (21.4 +/- 1.6%, n.s.). The RQ rose in both groups, but more in the patients with cirrhosis. At the end of the study, RQ was higher in patients (0.89 +/- 0.01) than in controls (0.85 +/- 0.01, p < 0.05). It is concluded that the nutrient-induced rise in energy expenditure during TPN is not significantly different in patients with cirrhosis and control subjects. Furthermore, the results indicate that the increased fat utilization in overnight fasting cirrhotic patients is rapidly shifted to an augmented carbohydrate oxidation during TPN, possibly as a consequence of marked hyperinsulinemia.
采用连续间接测热法测定了8例肝硬化患者和8名健康志愿者在基础状态下以及全胃肠外营养（TPN）3小时期间的能量消耗。TPN由葡萄糖、脂肪和氨基酸组成，葡萄糖/脂肪比例为50:50。输注速率设定为提供相当于个体测量的24小时静息能量消耗62.5%的能量。在基础状态下，患者和对照组的能量消耗相似，而患者的呼吸商（RQ）较低（0.78±0.01对0.82±0.01，均值±标准误，p<0.05）。在TPN期间，能量消耗在3小时输注期内逐渐增加。患者（19.1±1.2%）和对照组（21.4±1.6%，无显著性差异）的能量消耗平均升高相似。两组的RQ均升高，但肝硬化患者升高得更多。在研究结束时，患者的RQ（0.89±0.01）高于对照组（0.85±0.01，p<0.05）。得出的结论是，TPN期间营养物质诱导的能量消耗增加在肝硬化患者和对照受试者中无显著差异。此外，结果表明，过夜禁食的肝硬化患者增加的脂肪利用在TPN期间迅速转变为增强的碳水化合物氧化，这可能是显著高胰岛素血症的结果。
