肝硬化男性静息能量消耗增加的相关因素。

Factors related to increased resting energy expenditure in men with liver cirrhosis.

作者信息

Prieto-Frías César, Conchillo Marian, Payeras Marina, Iñarrairaegui Mercedes, Davola Delia, Frühbeck Gema, Salvador Javier, Rodríguez Macarena, Richter José Á, Mugueta Carmen, Gil María J, Herrero Ignacio, Prieto Jesús, Sangro Bruno, Quiroga Jorge

机构信息

aDepartment of Gastroenterology bLiver Unit, Department of Medicine cDepartment of Endocrinology dDepartment of Nuclear Medicine eDepartment of Laboratory Medicine, Clínica Universidad de Navarra fInstitute for Biomedical Research in Navarra (IDISNA), Pamplona gBiomedical Research Network in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain.

出版信息

Eur J Gastroenterol Hepatol. 2016 Feb;28(2):139-45. doi: 10.1097/MEG.0000000000000516.

DOI:10.1097/MEG.0000000000000516

PMID:26560751

Abstract

OBJECTIVE

Hypermetabolism in cirrhosis is associated with a high risk of complications and mortality. However, studies about underlying mechanisms are usually focussed on isolated potential determinants and specific etiologies, with contradictory results. We aimed at investigating differences in nutrition, metabolic hormones, and hepatic function between hypermetabolic and nonhypermetabolic men with cirrhosis of the liver.

PATIENTS AND METHODS

We prospectively enrolled 48 male cirrhotic inpatients. We evaluated their resting energy expenditure (REE) and substrate utilization by indirect calorimetry, body composition by dual-energy X-ray absorptiometry, liver function, and levels of major hormones involved in energy metabolism by serum sample tests. Patients with ascites, specific metabolic disturbances, and hepatocellular carcinoma were excluded.

RESULTS

REE and REE adjusted per fat-free mass (FFM) were significantly increased in cirrhotic patients. Overall, 58.3% of cirrhotic patients were classified as hypermetabolic. Groups did not differ significantly in age, etiology of cirrhosis, liver function, presence of ascites, use of diuretics, β-blockers, or presence of transjugular intrahepatic portosystemic shunts. Hypermetabolic cirrhotic patients had lower weight, BMI (P<0.05), nonprotein respiratory quotient (P<0.01), leptin (P<0.05), and leptin adjusted per fat mass (FM) (P<0.05), but higher FFM% (P<0.05) and insulin resistance [homeostatic model assessment-insulin resistance (HOMA-IR)] (P<0.05). Only HOMA-IR, leptin/FM, and FFM% were independently related to the presence of hypermetabolism.

CONCLUSION

Hypermetabolic cirrhotic men are characterized by lower weight, higher FFM%, insulin resistance, and lower leptin/FM when compared with nonhypermetabolic men. HOMA-IR, FFM%, and leptin/FM were independently associated with hypermetabolism, and may serve as easily detectable markers of this condition in daily clinical practice.

摘要

目的

肝硬化患者的高代谢与并发症及死亡风险增加相关。然而，关于潜在机制的研究通常聚焦于孤立的潜在决定因素和特定病因，结果相互矛盾。我们旨在研究肝硬化高代谢男性与非高代谢男性在营养、代谢激素和肝功能方面的差异。

患者与方法

我们前瞻性纳入了48例男性肝硬化住院患者。通过间接测热法评估其静息能量消耗（REE）和底物利用情况，通过双能X线吸收法评估身体成分，通过血清样本检测评估肝功能以及参与能量代谢的主要激素水平。排除有腹水、特定代谢紊乱和肝细胞癌的患者。

结果

肝硬化患者的REE及按去脂体重（FFM）调整后的REE显著升高。总体而言，58.3%的肝硬化患者被归类为高代谢。两组在年龄、肝硬化病因、肝功能、腹水情况、利尿剂使用、β受体阻滞剂使用或经颈静脉肝内门体分流术情况方面无显著差异。高代谢肝硬化患者体重、体重指数（BMI）较低（P<0.05），非蛋白呼吸商较低（P<0.01），瘦素水平较低（P<0.05），按脂肪量（FM）调整后的瘦素水平较低（P<0.05），但去脂体重百分比（FFM%）较高（P<0.05）且胰岛素抵抗[稳态模型评估-胰岛素抵抗（HOMA-IR）]较高（P<0.05）。只有HOMA-IR、瘦素/FM和FFM%与高代谢的存在独立相关。