Dolz C, Raurich J M, Ibáñez J, Obrador A, Marsé P, Gayá J
Department of Gastroenterology, Hospital Son Dureta, Palma de Mallorca, Spain.
Gastroenterology. 1991 Mar;100(3):738-44. doi: 10.1016/0016-5085(91)80019-6.
The purpose of this study was to investigate the effect of ascites on the energy metabolism of patients with liver cirrhosis. The resting energy expenditure was determined in 10 patients with liver cirrhosis and ascites of moderate or large volume. The resting energy expenditure measurement was performed using indirect calorimetry and the resting energy expenditure predictive value was calculated with the Harris-Benedict equation, both before and after removal of ascitic fluid by paracentesis. Metabolic stress factors were absent in all cases. After an interval of 11.2 +/- 7.7 days between measurements, a weight loss of 16.6 +/- 10.3 kg was observed with paracentesis. The resting energy expenditure measured by indirect calorimetry showed a statistically significant decrease from 1682 +/- 291 to 1523 +/- 240 kcal/day (P less than 0.005) after removal of ascites. The repeatability of our indirect calorimetry method only allowed for the analysis of the results in 4 of 10 patients in whom ascites removal produced a consistent decrease in resting energy expenditure. There were no statistically significant differences between the measurements obtained by indirect calorimetry and those provided by the Harris-Benedict equation, but the latter had a moderate reliability in predicting the real resting energy expenditure of every patient. Our results suggest that, far from being an inert volume, ascites may be associated, at least in some patients, with an increased resting energy expenditure and therefore accelerate the appearance of protein energy malnutrition with corresponding complications.
本研究的目的是调查腹水对肝硬化患者能量代谢的影响。对10例伴有中大量腹水的肝硬化患者测定其静息能量消耗。在通过腹腔穿刺放腹水前后，均使用间接测热法进行静息能量消耗测量，并使用哈里斯-本尼迪克特方程计算静息能量消耗预测值。所有病例均不存在代谢应激因素。两次测量间隔11.2±7.7天，腹腔穿刺放腹水后观察到体重减轻16.6±10.3kg。间接测热法测得的静息能量消耗在放腹水后从1682±291千卡/天显著降至1523±240千卡/天（P<0.005）。我们间接测热法的可重复性仅允许对10例患者中的4例结果进行分析，这4例患者放腹水后静息能量消耗持续下降。间接测热法获得的测量值与哈里斯-本尼迪克特方程提供的测量值之间无统计学显著差异，但后者在预测每位患者的实际静息能量消耗方面可靠性一般。我们的结果表明，腹水远非一个惰性容量，至少在某些患者中，可能与静息能量消耗增加相关，从而加速蛋白质能量营养不良及相应并发症的出现。
