慢加急性肝功能衰竭病人维生素B_1的缺乏与补充  

The deficiency and supplementation of vitamin B_1 in patients with acute on chronic liver failure

作　　者：李雪梅[1] 侯维[1] 黄沛力[2] 于红卫[1] 李娟[1] 冯岩梅[1] 王馨[1] 孟庆华[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病内分泌科,北京100069 [2]首都医科大学公共卫生与家庭医学学院,北京100069

出　　处：《肠外与肠内营养》2013年第2期72-74,共3页Parenteral & Enteral Nutrition

基　　金：北京市病毒性肝炎重大科技项目(H020920020890)

摘　　要：目的:评价慢加急性肝功能衰竭(ACLF)病人维生素B1的营养状况、缺乏原因以及常规补充治疗效果。方法:选择ACLF早、中期病人26例,用膳食营养软件记录分析病人入院3 d饮食中维生素B1摄入量。按标准治疗量(30 mg/d)连续治疗10 d,留取治疗前后的静脉血液和24 h尿液标本,分别检测维生素B1的含量。按预后将病人分为好转组和恶化组。结果:88.5%(23/26例)的病人摄入维生素B1不足或缺乏,最低摄入量不足正常人体需要量的1/10。血液检查证实治疗前100%缺乏维生素B1,治疗后仍有61.5%的病人缺乏维生素B1,15.4%的病人维生素B1不足。治疗前后血维生素B1检测结果有统计学差异。尿检34.5%的病人维生素B1缺乏或不足,治疗后所有病人尿检正常;尿维生素B1排出量与尿量相关。服药后血维生素B1与预后相关。结论:ACLF病人维生素B1摄入严重不足,补充常规剂量的维生素B1可明显改善病人的营养状况,但仍显不足。治疗后仍缺乏维生素B1的病人预后差。Objective： To measure the nutritional status of VitB1 in ACLF patients, analyze the reasons of Vitamin B1 deficiency and evaluate the effect of routine supplementation therapy. Methods ： Twenty-six patients with early or medium stage acute on chronic liver failure were enrolled. The intake of vitamin B1 in the first three days of hospitalization were analyzed by Diet Analysis Plus Software. Continuous treatment were administrated for 10 days in accordance with the standard therapeutic dose （30 mg/ day）, venous blood and 24 hour urine specimens were collected before and after the treatment,the level of VitB1 were detected by TPP method and fluorescence detection. Patients were divided into remission and aggravated groups by prognosis. Results： The proportion of insufficient intake of VitB1 was 88.5 % （23/26） ,the lowest one was less than one tenth of the body needed. The inadequate rate of VitB1 by serological tests was 100%. After treatment, 15.4% patients had insufficient intake and 61.5% patients had Vitamin B1 deficiency. The level of VitB1 before treatment was significant lower than the level after treatment. The inadequate rate of VitB1 in urine was 34.5%, all patients reached the normal level after treatment. The level of VitB1 in urine was correlated with urine volume. The level of VitBl in serum was related to prognosis. Conclusion ： The intake of VitB1 was severe shortage in ACLF patients, the urine volume was closely related to the loss of VitB1 in urine,which result in the severe deficiency of VitB1. To supplement VitB1 in conventional dose will significantly increase the level of VitB1 in serum,but it is still insufficient. The lack of VitB1 in spite of supplement therapy were with poor prognosis in the ACLF patients.

关 键 词：慢加急性肝功能衰竭 维生素B1缺乏与补充 

分 类 号：R575.3[医药卫生—消化系统] R591.421[医药卫生—内科学]