Prognostic value of energy metabolism in patients with viral liver cirrhosis
Prognostic value of energy metabolism in patients with viral liver cirrhosis
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DOI：
10.1016/s0899-9007(01)00754-7
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发表时间：
2002-03-01
期刊：
影响因子：
4.4
通讯作者：
Moriwaki, H
中科院分区：
文献类型：
--
作者：
Tajika, M;Kato, M;Moriwaki, H
能量营养不良对非酒精性肝硬化患者生存率的影响尚未明确。我们在研究开始时描述了能量代谢的特点，并前瞻性地分析了其对患者随后生存的影响。109名连续的病毒性肝硬化患者和22名健康对照受试者参加了这项研究。采用间接量热法测定卧床过夜和禁食后的静息能量消耗（REE），计算非蛋白质呼吸商（npRQ）。随访患者生存8年。采用Kaplan-Meier法估计生存率。入院时REE显著高于预测的基础代谢率（BMR）（P < 0.001）。哮喘组NpRQ显著低于对照组（P < 0.001）。低npRQ（< 0.85）患者的生存率显著低于评分> 0.85的患者（P < 0.01），而正常代谢患者（0.9 < REE/BMR < 1.1）的生存率显著高于低代谢（REE/BMR < 0.9）或高代谢（1.1 < REE/BMR）患者（P < 0.05）。比例风险模型显示，npRQ（相对危险度= 0.0003，95%可信区间= 0.0000-0.0970）、REE/BMR（0.0199，0.0007-0.5652）、凝血酶原时间和氨是决定生存率的独立显著因素。因此，能量代谢的评估可以用来预测病毒性肝硬化患者的生存。(C)Elsevier Science Inc. 2002.
The effect of energy malnutrition on survival in patients with non-alcoholic viral liver cirrhosis has not been well defined. We characterized energy metabolism at study entrance and prospectively analyzed its effect on subsequent survival in cirrhotics. One hundred nine consecutive patients with viral liver cirrhosis and 22 healthy control subjects participated in the study. By indirect calorimetry after overnight bedrest and fasting, resting energy expenditure (REE) was measured and non-protein respiratory quotient (npRQ) was calculated. Survival of cirrhotics were followed for up to 8 y. Survival rate was estimated with the Kaplan-Meier method. REE at entrance was significantly higher than the predicted basal metabolic rate (BMR) in cirrhotics (P < 0.001). NpRQ was significantly lower in cirrhotics than in controls (P < 0.001). Survival rate was significantly lower in patients with low npRQ ( < 0.85) than in patients with scores above 0.85 (P < 0.01) and was significantly higher in normal metabolic patients (0.9 < REE/BMR < 1.1) than in hypometabolic (REE/BMR < 0.9) or hypermetabolic (1.1 < REE/BMR) patients (P < 0.05). The proportional hazards model showed that npRQ (relative risk = 0.0003, 95% confidence interval = 0.0000-0.0970), REE/BMR (0.0199, 0.0007-0.5652), prothrombin time, and ammonia were independent significant factors determining survival. Thus evaluation of energy metabolism can be used to predict survival in patients with viral liver cirrhosis. (C) Elsevier Science Inc. 2002.