Schneeweiss B, Pammer J, Ratheiser K, Schneider B, Madl C, Kramer L, Kranz A, Ferenci P, Druml W, Grimm G
Department of Internal Medicine IV, University of Vienna, Austria.
Gastroenterology. 1993 Nov;105(5):1515-21. doi: 10.1016/0016-5085(93)90159-a.
Conflicting data are available concerning energy metabolism in liver disease. Changes should be most pronounced in acute hepatic failure in which loss of 85% of liver cell mass is reported. Metabolic rate could be decreased due to impairment in liver mass but may also be increased as a result of systemic-mediator actions. To clarify this issue we studied energy metabolism in acute hepatic failure.
Energy metabolism was evaluated by indirect calorimetry in 12 patients with acute liver failure and 22 sex-, age-, and body size-matched healthy individuals. In controls and 5 patients, studies were performed in the postabsorptive state; the remaining 7 patients received glucose at a rate of 8 mumol/kg body weight.min to prevent hypoglycemia.
Resting energy expenditure was increased in acute liver failure compared with healthy controls (5.1 +/- 0.14 kJ.min-1 x 1.73 m-2 vs. 3.97 +/- 0.08 kJ.min-1 x 1.73 m-2; mean +/- SEM; P < 0.001). Respiratory quotient and oxidation rates for major fuels were not different between the total patient-group and controls. In patients without glucose supply, energy derived from fat was higher and from carbohydrate lower than in healthy controls and patients with glucose supply.
Energy expenditure is increased in acute liver failure. Altered substrate oxidation can be normalized by glucose supply.
关于肝病时能量代谢的数据相互矛盾。在急性肝衰竭中变化可能最为显著，据报道此时肝细胞质量损失达85%。代谢率可能因肝质量受损而降低，但也可能因全身介质的作用而升高。为阐明这一问题，我们对急性肝衰竭时的能量代谢进行了研究。
通过间接测热法对12例急性肝衰竭患者和22例性别、年龄及体型匹配的健康个体进行能量代谢评估。对对照组和5例患者在空腹状态下进行研究；其余7例患者以8 μmol/（kg体重·分钟）的速率输注葡萄糖以预防低血糖。
与健康对照组相比，急性肝衰竭患者静息能量消耗增加（5.1±0.14 kJ·分钟-1×1.73 m-2 对3.97±0.08 kJ·分钟-1×1.73 m-2；均值±标准误；P<0.001）。患者组总体与对照组相比，主要燃料的呼吸商和氧化率无差异。在未补充葡萄糖的患者中，脂肪供能高于健康对照组和补充葡萄糖的患者，碳水化合物供能则低于健康对照组和补充葡萄糖的患者。
急性肝衰竭时能量消耗增加。补充葡萄糖可使底物氧化异常恢复正常。
