Campillo B, Bories P, Devanlay M, Wirquin E, Pornin B, Sommer F, Fouet P
Service d'Hépato-Gastroentérologie, Hôpital Albert-Chenevier, Créteil.
Gastroenterol Clin Biol. 1990;14(8-9):655-61.
The thermic effect of food was evaluated in 10 cirrhotic patients and 7 normal controls by indirect calorimetry during 6 hours following intake of a mixed meal supplying 15 kcal/kg of body weight and containing 30, 15 and 55 percent as lipid, protein and carbohydrate calories respectively. The rates of storage and oxidation of nutriments, as well as variations of blood glucose, insulin, plasma lactates, free fatty acids, glycerol, and ketonic corps were also evaluated. The thermogenic response to food was lower (p less than 0.025) and delayed in cirrhotic patients. In cirrhotic patients the rate of glucose oxidation was significantly increased (70.2 +/- 3.9 vs 50.4 +/- 3.9 percent of the glucose load; p less than 0.01) suggesting a defect in glycogen storage. These results can be related to insulin resistance as attested by a larger increase of glucose and insulin levels in cirrhotics than in controls (p less than 0.001 and p less than 0.001, respectively). Compared with controls, lipolysis in cirrhotic patients was more suppressed as shown by a sharper decrease of free fatty acids and glycerol levels (p less than 0.001 and p less than 0.02, respectively). Furthermore, the rate of lipid oxidation decreased more in cirrhotic as compared with controls (p less than 0.001) before becoming completely suppressed. De novo lipogenesis appeared between the 2nd and 4th hours. Consequently, the rate of lipid oxidation was significantly reduced in cirrhotic vs controls (14.3 +/- 5.0 vs 30.5 +/- 3.7 percent of the lipid load; p less than 0.02) showing an increased rate of lipid storage.(ABSTRACT TRUNCATED AT 250 WORDS)
通过间接测热法，对10名肝硬化患者和7名正常对照者在摄入一顿提供15千卡/千克体重的混合餐（分别含有30%、15%和55%的脂质、蛋白质和碳水化合物热量）后的6小时内进行食物热效应评估。同时还评估了营养物质的储存和氧化速率，以及血糖、胰岛素、血浆乳酸、游离脂肪酸、甘油和酮体的变化。肝硬化患者对食物的产热反应较低（p<0.025）且延迟。在肝硬化患者中，葡萄糖氧化速率显著增加（葡萄糖负荷的70.2±3.9%对50.4±3.9%；p<0.01），提示糖原储存存在缺陷。这些结果可能与胰岛素抵抗有关，因为肝硬化患者血糖和胰岛素水平的升高幅度大于对照组（分别为p<0.001和p<0.001）。与对照组相比，肝硬化患者的脂肪分解受到更明显的抑制，游离脂肪酸和甘油水平下降更显著（分别为p<0.001和p<0.02）。此外，肝硬化患者脂质氧化速率在完全被抑制之前比对照组下降得更多（p<0.001）。在第2至4小时出现了从头脂肪生成。因此，肝硬化患者的脂质氧化速率显著低于对照组（脂质负荷的14.3±5.0%对30.5±3.7%；p<0.02），表明脂质储存速率增加。（摘要截断于250字）
