乙型肝炎病毒相关慢性肝病患者的能量代谢特点与继发细菌感染的风险  

Energy metabolism characteristic with risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease

作　　者：林升龙 林明华 王香梅 陈秀敏 叶寒辉 马华晳 张冬青 吴雯军 林佳煌 廖资渊 郑瑞丹 高海兵 Lin Shenglong;Lin Minghua;Wang Xiangmei;Chen Xiumin;Ye Hanhui;Ma Huaxi;Zhang Dongqing;Wu Wenjun;Lin Jiahuang;Liao Ziyuan;Zheng Ruidan;Gao Haibing(Department of Hepatology,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China;Department of Hepatology,Zhengxing Hosptial,Zhangzhou 363000,China)

机构地区：[1]福建医科大学孟超肝胆医院肝内科,福州350025 [2]漳州正兴医院肝内科,漳州363000

出　　处：《中华肝脏病杂志》2021年第6期558-564,共7页Chinese Journal of Hepatology

基　　金：福建省临床重点专科建设项目资助。

摘　　要：目的探讨乙型肝炎病毒相关慢性肝病的能量代谢特点,并分析能量代谢指标与患者继发细菌感染风险的相关性。方法收集和分析2017年11月至2020年11月福建医科大学孟超肝胆医院收治住院的183例患者的回顾性资料,包括慢性乙型肝炎患者79例、乙型肝炎肝硬化患者51例和乙型肝炎肝衰竭患者53例,其中肝衰竭患者和失代偿期肝硬化患者被定义为重症肝病组;使用Quark RMR间接能量代谢检测仪(购自意大利COSMED公司)检测患者的能量代谢情况,并记录患者住院期间发生的继发细菌感染事件。连续变量数据采用Shapiro-Wilk检验和正态Q-Q图分析数据的正态分布情况,符合正态分布,采用均值±标准差进行描述;不符合正态分布,则采用中位数和四分位间距进行描述。采用Levene检验对数据进行方差齐性检验,方差齐且符合正态分布,采用t检验比较两组样本的均值;采用单因素方差分析比较3组样本的均值,然后采用Tukey's检验进行两组间比较。方差不齐或不符合正态分布,则采用Wilcoxon秩和检验比较两组差异;采用Kruskal-Wallis检验(H检验)比较3组样本的差异,然后采用Dunnett检验(Z检验)进行两组间比较。分类变量数据采用卡方检验进行分析。采用Logistic回归分析筛选独立危险因素,变量纳入标准为P<0.05。结果3组患者的呼吸熵(RQ)和非蛋白呼吸熵(npRQ)差异有统计学意义(P<0.05),其中慢性乙型肝炎组的RQ和npRQ较乙型肝炎肝硬化组、乙型肝炎肝衰竭组均显著升高(P值均<0.05)。3组患者的脂肪氧化率和碳水化合物氧化率差异有统计学意义(P<0.05),其中与乙型肝炎肝硬化组和乙型肝炎肝衰竭组相比,慢性乙型肝炎组的脂肪氧化率较低,碳水化合物氧化率则较高(P<0.05)。3组患者的静息能量消耗实测值和预测值、蛋白质氧化率差异均无统计学意义。在重症肝病患者中,继发细菌感染发生率为48.39%(45/93),与�Objective To investigate and analyze the energy metabolism characteristics and the correlation between energy metabolism and the risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease(HBV-CLD).Methods Data of 183 cases admitted to the Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2020 were retrospectively analyzed.79 cases of chronic hepatitis B,51 cases of hepatitis B-related liver cirrhosis,and 53 cases of hepatitis B-related liver failure were collected.Among them patients with liver failure and decompensated liver cirrhosis were defined as severe liver disease group.The Quark RMR indirect calorimetry(COSMED Corporation,Italy)was used to exam the patients'energy metabolism condition,and the incidences of secondary bacterial infection of the patients during hospitalization were recorded.Shapiro-Wilk test and normal QQ plot were used to analyze the normal distribution of continuous variable data,which was consistent with the normal distribution and was described by mean±standard deviation.In addition,if it did not conform to the normal distribution,the median and interquartile distance were used to describe it.Levene’s test was used to test the homogeneity of variance of the data,which was consistent with the normal distribution.The t-test was used to compare the means of the two groups of samples.One-way analysis of variance was used to compare the mean values of the three groups of samples,and then the Tukey's test was used to compare the two groups.If the variance was uneven or did not conform to the normal distribution,the Wilcoxon rank sum test was used to compare the differences between the two groups.Kruskal-Wallis test(H test)was used to compare the differences between the three groups of samples,and then the Dunnett’s test(Z test)was used for comparison between the two groups.Categorical variable data were analyzed using chi-square test.Logistic regression analysis was used to screen independent risk facto

关 键 词：乙型肝炎病毒 间接检测 能量代谢 继发感染 

分 类 号：R512.62[医药卫生—内科学] R575[医药卫生—临床医学]