不同方法测定重症急性胰腺炎患者能量消耗值的一致性和相关性研究  

Study on the consistency and correlation of different methods for measuring energy consumption in patients with severe acute pancreatitis

作　　者：刘婧 吴遥 黄鑫[1] 柯华婧[1] 雷宇鹏[1] 何文华[1] 祝荫[1] 吕农华[1] 夏亮[1] Liu Jing;Wu Yao;Huang Xin;Ke Huajing;Lei Yupeng;He Wenhua;Zhu Yin;Lyu Nonghua;Xia Liang(Department of Gastroenterology,the First Affiliated Hospital of Nanchang Medical University,Nanchang 330000,China)

机构地区：[1]南昌大学第一附属医院消化内科,南昌330000

出　　处：《中华消化杂志》2022年第6期378-382,共5页Chinese Journal of Digestion

基　　金：国家自然科学基金资助项目(82060125);江西省科技创新杰出青年人才培养计划(20192BCB23021);江西省自然科学基金(20202BAB206010)。

摘　　要：目的分析间接测热法(IC)与哈里斯-本尼迪克特估算法(H-B)测定重症急性胰腺炎(SAP)患者能量消耗的一致性和相关性,以及不同病因SAP患者的静息能量代谢特点,以指导临床目标能量营养支持方案的制订。方法纳入2019年2月1日至12月31日入住南昌大学第一附属医院重症监护室的61例SAP患者,收集患者的相关资料如SAP病因,是否需要机械通气,以及代谢状态等。所有患者入住重症监护室后第1天接受IC测定,根据IC测定的能量消耗值(以下简称IC值)与H-B测定的能量消耗值(以下简称H-B值)确定SAP患者处于高、正常或低代谢状态。采用Bland-Altman法和Pearson线性回归分析2种方法测定能量消耗值的一致性、相关性,并拟合线性方程。统计学方法采用配对t检验。结果61例SAP患者中,13例为胆源性SAP,30例为高脂血症性SAP,6例为酒精性SAP,12例为其他原因或未明原因SAP;19例需机械通气,42例无需机械通气;70.5%(43/61)的SAP患者处于高代谢状态,13.1%(8/61)的患者处于正常代谢状态,16.4%(10/61)的患者处于低代谢状态。61例SAP患者的IC值高于H-B值[(8604.7±367.8)kJ/d比(6491.2±133.7)kJ/d],差异有统计学意义(t=5.95,P<0.001)。高脂血症性、酒精性和胆源性SAP患者的IC值分别为(8815.2±537.9)、(7631.2±890.5)、(8108.0±933.1)kJ/d,H-B值分别为(6869.6±204.5)、(5916.8±153.7)、(5974.2±200.9)kJ/d,胆源性和高脂血症性SAP患者的IC值分别高于各自的H-B值,差异均有统计学意义(t=2.29、3.38,均P<0.05)。需机械通气与无需机械通气SAP患者的IC值和H-B值分别为(10485.0±741.1)、(6462.6±222.8)kJ/d,(6595.1±364.7)、(6503.2±166.7)kJ/d,需机械通气SAP患者的IC值高于其H-B值和无需机械通气者的IC值,差异均有统计学意义(t=4.71、5.20,均P<0.001)。Bland-Altman法一致性分析显示,2种方法存在明显偏倚,平均偏倚值为92.2 kJ/d;Pearson线性回归分析显示二者存在线性关系(r=0.44,P<0.001),一元回Objective To analyze the consistency and correlation of indirect calorimetry(IC)and Harris-Benedict estimation method(H-B)in measuring energy consumption in patients with severe acute pancreatitis(SAP),as well as the characteristics of energy metabolism at resting state of SAP patients with different etiologies,and so as to guide the formulation of clinical energy nutrition support program.Methods From February 1 to December 31,2019,61 SAP patients admitted into the intensive care unit of the First Affiliated Hospital of Nanchang University were enrolled.Collected relevant data of patients,such as the etiology of SAP,whether mechanical ventilation was needed,as well as the metabolic status.All SAP patients accepted IC test on the first day after admission to intensive care unit.According to the energy consumption measured by IC(hereinafter referred to as IC value)and the energy consumption measured by H-B(hereinafter referred to as H-B value),SAP patients were determined to be in high,normal or low metabolic state.Bland-Altman method and Pearson linear regression were used to analyze the consistency and correlation of the two methods in measuring energy consumption,and the linear equation was fitted.Paired t test was used for statistical analysis.Results Among the 61 SAP patients,13 cases were biliary SAP,30 cases were hyperlipidemic SAP,6 cases were alcoholic SAP,and 12 cases were SAP of other causes or unknown causes.Nineteen cases needed mechanical ventilation and 42 cases did not need mechanical ventilation.There were 70.5%(43/61)of SAP patients in high metabolic state,13.1%(8/61)of SAP patients in normal metabolic state,and 16.4%(10/61)of SAP patients in low metabolic state.The IC value in 61 SAP patients was higher than H-B value((8604.7±367.8)kJ/d vs.(6491.2±133.7)kJ/d),and the difference was statistically significant(t=5.95,P<0.001).The IC value in patients with hyperlipidemic,alcoholic and biliary SAP was(8815.2±537.9),(7631.2±890.5),and(8108.0±933.1)kJ/d,respectively,and the H-B value was(6869.6±2

关 键 词：重症急性胰腺炎 代谢状态 量热法 间接 经验估算法 

分 类 号：R576[医药卫生—消化系统]