脑性瘫痪患儿静息能量消耗的临床横断面研究  

A clinical cross-sectional study of resting energy expenditure in children with cerebral palsy

作　　者：朱登纳[1,2,3] 史凯丽 乔俊英 王军[1,2,3] 陈功勋[1,2,3] 牛国辉 李兵兵 王明梅[1,2,3] Zhu Dengna;Shi Kaili;Qiao Junying;Wang Jun;Chen Gongxun;Niu Guohui;Li Bingbing;Wang Mingmei(Department of Children Rehabilitation,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Henan Pediatric Clinical Research Center,Zhengzhou 450052,China;Henan Key Laboratory of Child Brain Injury,Zhengzhou 450052,China;Pediatric Intensive Care Unit,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院儿童康复科,郑州450052 [2]河南省儿科疾病临床医学研究中心,郑州450052 [3]河南省小儿脑损伤重点实验室,郑州450052 [4]郑州大学第三附属医院儿童重症监护室,郑州450052

出　　处：《中华实用儿科临床杂志》2023年第8期580-585,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ2018047)。

摘　　要：目的:观察不同粗大运动功能分级(GMFCS)脑性瘫痪(简称脑瘫)患儿的静息能量消耗(REE)特点,探讨常用REE预测公式在脑瘫患儿中的一致性及相关性。方法:回顾性研究。选取2021年9月至2022年8月在郑州大学第三附属医院就诊的36例24~144月龄脑瘫患儿为研究对象,11例健康儿童为对照组。应用间接测热法测定REE,脑瘫组按照GMFCS分为Ⅰ~Ⅱ级(20例)、Ⅲ级(6例)、Ⅳ~Ⅴ级(10例)3组,分别与对照组进行REE实测值(MREE)比较;Harris-Benedict、WHO、Schofield-W、Schofield-WH及Oxford预测公式的预测值(PREE)与MREE进行一致性、相关性等分析。独立样本应用t检验或Mann-Whitney U检验进行分析,分类资料应用χ^(2)检验;采用配对t检验、Pearson线性相关性分析对MREE与PREE的相关性进行分析;采用均方根误差评估各REE预测公式PREE值的准确性。结果:对照组MREE为(952.18±270.56)kcal/d,脑瘫儿童MREE为(801.81±201.89)kcal/d。Ⅰ~Ⅱ级组MREE为(868.30±194.81)kcal/d,Ⅲ级组MREE为(813.17±192.48)kcal/d,与对照组比较,差异均无统计学意义(均P>0.05);Ⅳ~Ⅴ级组MREE为666.00(513.50,775.50)kcal/d,与对照组比较,差异有统计学意义(P=0.011)。Harris-Benedict、WHO、Schofield-W、Schofield-WH、Oxford公式的PREE与MREE比较,差异均无统计学意义(均P>0.05),正确分类率分别为33.3%、47.2%、41.7%、47.2%、41.7%;相关系数分别为0.585、0.700、0.703、0.712、0.701;一致性界限分别为(-297.77,359.22)、(-245.60,326.94)、(-250.62,316.05)、(-242.22,177.36)、(-241.28,325.81),临床可接受范围为-80.18~80.18 kcal/d;均方根误差分别为168.09 kcal/d、149.64 kcal/d、146.24 kcal/d、144.23 kcal/d、148.77 kcal/d。结论:CMFCSⅣ和Ⅴ级患儿的MREE值显著下降,当无法通过间接测热法监测脑瘫患儿的REE值制定营养支持方案时,临床可优先考虑应用Schofield-WH预测公式计算脑瘫患儿的REE值。ObjectiveTo investigate the characteristics of resting energy expenditure(REE)in children with cerebral palsy(CP)graded with different levels of Gross Motor Function Classification System(GMFCS),and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.MethodsIt was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS,children with CP were divided into gradeⅠ-Ⅱgroup(20 cases),gradeⅢgroup(6 cases)and gradeⅣ-Ⅴgroup(10 cases).During the same period,11 age-matched healthy children were included in control group.The measured REE(MREE)between children with CP and healthy controls was compared.Predicted REE(PREE)calculated by the Harris-Benedict,WHO,Schofield-W,Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann-Whitney U test,and categorical data were analyzed using Chi-square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error.ResultsThe MREE in control group and children with CP were(952.18±270.56)kcal/d and(801.81±201.89)kcal/d,respectively.There was no significant difference in the MREE between gradeⅠ-Ⅱgroup versus control group[(868.30±194.81)kcal/d vs.(952.18±270.56)kcal/d,P>0.05],and gradeⅢgroup versus control group[(813.17±192.48)kcal/dvs.(952.18±270.56)kcal/d,P>0.05].The MREE was significantly lower in gradeⅣ-Ⅴgroup than that of control group[666.00(513.50,775.50)kcal/dvs.(952.18±270.56)kcal/d,P=0.011].There were no significant difference between MREE and PREEs calculated by Harris-Benedict,WHO,Schofield-W,Schofield-WH,and Oxford(allP>0.05).The correct classification f

关 键 词：脑性瘫痪 粗大运动功能分级 静息能量消耗 间接测热法 一致性界限 

分 类 号：R742.3[医药卫生—神经病学与精神病学]