Recovery of nutritional metabolism after liver transplantation.
Recovery of nutritional metabolism after liver transplantation.
复制标题
肝移植后营养代谢的恢复。
DOI：
10.1016/j.nut.2014.05.016
复制
发表时间：
2015
期刊：
影响因子：
4.4
通讯作者：
Takeda E.
中科院分区：
文献类型：
--
作者：
Sugihara K;Yamanaka-Okumura H;Teramoto A;Urano E;Katayama T;Morine Y;Imura S;Utsunomiya T;Shimada M;Takeda E.
围手术期营养评估对于反映营养管理至关重要，因为肝移植（LTx）通常是在营养状况较差的患者中进行的。本研究的目的是评估营养状况，包括非蛋白质呼吸商（npRQ），静息能量消耗（REE），氮平衡，和血液生化指标在LTx之前和之后。在LTx前和术后2、3、4周用间接量热法测定npRQ和REE。血液生化和氮平衡计算的24小时尿液收集同时进行间接热量测量;结果进行了比较两组之间。ResultsBefore LTx，npRQ显着降低，血清非酯化脂肪酸水平显着高于患者比对照组。此外，在患者中观察到负氮平衡。然而，这些在LTx后4周显著改善。与术前相比，受体的REE没有显著增加。血生化显示血清胆碱酯酶和白蛋白水平逐渐升高。这些未能达到正常水平4 wk posttransplant.ConclusionsThe研究结果表明，LTx后营养代谢的改善可能需要4周。因此，可能需要额外的营养策略，以尽量减少移植后早期的分解代谢状态。在LTx前后应对这些患者进行充分的、个性化的营养指导。
ObjectivePerioperative nutritional assessment is critically important to reflect nutritional management because liver transplantation (LTx) often is undertaken in patients with poor nutritional status. The aim of this study was to evaluate nutritional status, including the non-protein respiratory quotient (npRQ), resting energy expenditure (REE), nitrogen balance, and blood biochemical parameters in patients before and after LTx.MethodsFourteen patients undergoing LTx and 10 healthy controls were enrolled in this study. The npRQ and REE were measured using indirect calorimetry before LTx and at 2, 3, and 4 wk after the procedure. Blood biochemistry and nitrogen balance calculated by 24-h urine collection were performed concurrently with indirect calorimetric measurement; the results were compared between the two groups.ResultsBefore LTx, npRQ was significantly lower and serum non-esterified fatty acid levels were significantly higher in the patients than in the controls. Furthermore, a negative nitrogen balance was observed in the patients. These, however, improved significantly at 4 wk after LTx. REE did not significantly increase compared with the preoperative values in recipients. Blood biochemistry showed gradually increasing levels of serum cholinesterase and albumin. These failed to reach to normal levels by 4 wk post-transplant.ConclusionsThe findings revealed that improvement of nutritional metabolism after LTx may require 4 wk. Additional nutritional strategies, therefore, may be needed to minimize catabolic state during the early post-transplant period. Adequate, individualized nutritional guidance before and after LTx should be performed in these patients.