恶性肿瘤患者能量、物质代谢及机体组成变化  

Assessment of energy expenditure and body composition in cancer patients

作　　者：吴国豪[1] 曹冬兴[1] 魏嘉[1] 全应军[1] 吴肇汉[1] 

机构地区：[1]上海复旦大学附属中山医院普外科,200032

出　　处：《中华外科杂志》2008年第24期1906-1909,共4页Chinese Journal of Surgery

摘　　要：目的评价恶性肿瘤患者能量消耗、物质代谢和机体组成变化。方法2004年9月至2008年3月应用间接测热法测定936例恶性肿瘤患者和840例非恶性肿瘤患者静息能量消耗、碳水化合物及脂肪氧化率；应用生物电阻抗法测定所有研究对象机体总体水、细胞外液、细胞内液、体脂及瘦组织群含量。结果恶性肿瘤患者静息能量消耗测定值与对照组差异无统计学意义[（1452．2±196．4）kcal／d vs．（1429．5±182．6）kcal／d，P=0．136]，但经瘦组织群和预测公式矫正后存在明显差异（P均〈0．05）。恶性肿瘤患者中48．6％为高代谢，42．9％为正常代谢，8．5％为低代谢，对照组则分别为22．5％、58．5％、19．0％。恶性肿瘤组脂肪氧化率高于对照组[（77．8±11．3）g／min vs．（67．1±12．2）g／min，P=0．000]，碳水化合物氧化率及非蛋白呼吸商低于对照组[（68．7±10．5）g／min vs.（88．8±12．1）g／min，P=0．000；0．782±0．012 vs.0．810±0．014，P=0．000]。恶性肿瘤患者体脂及瘦组织群含量低于对照组[（14．9±4．5）kg vs.（18．4±5．2）kg，P=0．000；（44．4±7．2）kg vs.（46．1±8．1）kg，P=0．008]。结论恶性肿瘤患者总体上处于高代谢状态，脂肪氧化增加，碳水化合物氧化降低，体脂、瘦组织群及细胞总体丢失。Objective To demonstrate the changes of resting energy expenditure （ REE）, substrate metabolism and body composition in cancer patients. Methods From September 2004 to March 2008, REE, carbohydrate oxidation（CO） and fat oxidation（FO） in 936 cancer patients and 840 control subjects were measured by indirect calorimetry. Bioelectrical impedance appliance was applied to assess intracellular fluid, extracellular fluid, fat mass （FM） and fat free mass （FFM） in the two groups. Results No difference in REE was found between the cancer patients and non-cancer patients [ （ 1452.2 ±196.4） kcal/ d vs. （ 1429.5 ±182. 6） kcal/d,P = 0. 1361. But REE/FFM and REE/pREE were elevated in cancer patients than in controls （ all P 〈 0. 05 ）. Of the cancer patients, 48. 6% were hypermetabolic, 42. 9% normal and 8. 5% hypometabolic, while those were 22. 5% , 58.5% and 19. 0% in controls. Cancer patients had higher FO [ （77.8 ±11.3） g/min vs. （67.1 ± 12. 1 ） g/min, P = 0. 000 ], lower CO and npRQ [（68.7±10.5）g/min vs. （88.8 ±12.1）g/min, P=0.000; 0.782 ±0.012 vs. 0.810 ±0.014, P= 0. 000 ]. Cancer patients exhibited lower FM and FFM [ （ 14. 9 ±4. 5 ） kg vs. （ 18.4± 5.2 ） kg, P = 0. 000 ; （44. 4 ± 7.2） kg vs. （ 46. 1± 8. 1 ） kg, P = 0. 008 ]. Conclusions Elevated REE is common in cancer patients. Substrate metabolism of the cancer patients features in increased FO, decreased CO and npRQ, which is correlated with the elevated REE. FM and FFM loses in proportion in cancer patients.

关 键 词：肿瘤 营养生理学 能量代谢 物质代谢 

分 类 号：R686[医药卫生—骨科学]