间接测热法与公式法测定失代偿期乙型肝炎肝硬化患者静息能量消耗临床意义探讨*

doi:10.3969/j.issn.1672-5069.2025.01.030

摘要/Abstract

摘要： 目的比较间接测热法与公式法测量失代偿期乙型肝炎肝硬化(DHBC)患者静息能量消耗(REE)的差异,为DHBC患者的营养干预和健康管理提供参考。方法 2020年6月～2023年6月我院收治的DHBC患者112例,采用间接测热法测定REE,并与Harris-Benedict(H-B)公式法推算结果进行比较。采用生物电阻抗法测量内脏和皮下脂肪面积,使用Martin Grohe仪测量身高,并输入至TANITA MC-180人体成分分析仪,检测体脂率、去脂体质量和基础代谢率。随访1年。结果间接测热法与H-B公式法检测总体DHBC患者REE分别为(1753.1±150.8)kcal/d和(1476.1±141.7)kcal/d,差异具有统计学意义(P<0.05);不同性别、年龄和BMI间两种方法检测的REE差异也具有统计学意义(P<0.05);不同体脂肪、内脏脂肪面积、皮下脂肪面积、体脂率、去脂体质量和基础代谢率的DHBC患者间接测热法测量的REE显著大于H-B公式法测量(P<0.05),而不同总水量、细胞内液和细胞外液亚组REE差异无统计学意义(P>0.05);随访1年,DHBC患者死亡21例(18.8%);不同体脂肪、内脏脂肪面积、体脂率和基础代谢率显著影响患者临床预后(P<0.05)。结论采用间接测热法测量DHBC患者REE可能更加准确,而采用H-B公式法推算结果存在低估的可能性。在采用间接测热法测定REE时,需考虑不同体脂肪、内脏脂肪面积、皮下脂肪面积、体脂率、去脂体质量和基础代谢率的影响。体脂率和基础代谢率较高的DHBC患者可能预后较差,需重点予以关注。

关键词: 肝硬化, 静息能量消耗, 间接测热法, Harris-Benedict公式法, 预后

Abstract: Objective The aim of this study was to compare indirect calorimetry and Harris-Benedict (H-B) formulain measuring resting energy expenditure (REE) in patients with decompensated hepatitis B-induced liver cirrhosis (DHBC), and to provide reference for nutritional intervention and health management of DHBC patients. Methods 112 patients with DHBC were admitted to our hospital between June 2020 and June 2023,and their REE was measured by indirect calorimetry or calculated by Harris-Benedict formula. All patients were followed-up for one year. Body fat, visceral fat area, subcutaneous fat area, body fat rate, fat-free weight and basal metabolic rate were obtained. Results REE of 112 patients with DHBC detected by indirect calorimetry and H-B formula were (1753.1±150.8)kcal/d/d and (1476.1±141.7)kcal/d/d, respectively, and the difference was statistically significant (P<0.05); there were significant differences in REE obtained by the two methods in different gender, ages and body mass index(P<0.05); the REE in different body fat, visceral fat areas, subcutaneous fat areas, body fat rates, fat-removed body weights and basal metabolic rates measured by indirect calorimetry were significantly higher than those by H-B formula calculation(P<0.05); there were no significant differences as respect to REE in different total water volume, intracellular fluid and extracellular fluid subgroups (P>0.05); by end of one-year follow-up, 21 patients (18.8%) with DHBC dies, and body fat, visceral fat areas, body fat rates and basal metabolic rates markedly influenced outcomes of the patients with DHBC(P<0.05). Conclusion Indirect calorimetry is more accurate in measuring REE in patients with DHBC, and the results calculated by H-B formula could be underestimated. When using indirect calorimetry to determine REE, it is necessary to consider the impact of different individual body composition indexes on the results, including body fat, visceral fat area, subcutaneous fat area, body fat rate, fat-free weight and basal metabolic rate. At the same time, the patients with DHBC with high body fat, large visceral fat area, high body fat rate and high basal metabolic rate might have a poor prognosis and needs careful management.

Key words: Liver cirrhosis, Resting energy expenditure, Indirect calorimetry, Harris-Benedict formula, Prognosis

许文慧, 许箐贇, 李彬彬, 潘超. 间接测热法与公式法测定失代偿期乙型肝炎肝硬化患者静息能量消耗临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(1): 116-119.

Xu Wenhui, Xu Jingyun, Li Binbin, et al. Comparison of indirect calorimetry and Harris-Benedict formulain measuring resting energy expenditure in patients with decompensated hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(1): 116-119.

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间接测热法与公式法测定失代偿期乙型肝炎肝硬化患者静息能量消耗临床意义探讨^*

Comparison of indirect calorimetry and Harris-Benedict formulain measuring resting energy expenditure in patients with decompensated hepatitis B-induced liver cirrhosis

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