多频生物电阻抗对肝硬化患者细胞内外液的探讨
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摘要
目的:探讨肝硬化患者细胞内外液分布的变化及机制.方法:采用多频生物电阻抗法对104例肝硬化患者根据Child-Pugh分级,分为A、B、C三组,并选择24例健康者作为对照组(N组),进行检测,各组受试者的细胞内液(intracellular water,ICW)、细胞外液(extracellular water,ECW)和身体总水(total body water,TBW),计算细胞内液/身体总水(ICW/TBW,ICW%)、细胞外液/身体总水(ECW/TBW,ECW%)和细胞外液/细胞内液(ICW/ECW),比较各组受试者细胞内、外液分布差异.结果:肝硬化患者各组间细胞内、外液分布发生变化,ICW%、ICW/ECW随肝功能恶化而降低,ECW随肝功能恶化而增加,ECW%随肝功能恶化而升高.A、B、C、N四组ICW%分别为61.07%±1.10%、60.03%±1.00%、59.48%±1.32%、61.48%±0.95%,ICW/ECW分别为1.571±0.072、1.510±0.063、1.470±0.789、1.598±0.065,ECW分别为13.011 L±2.517 L、14.463 L±2.720 L、14.587 L±2.976 L、13.300 L±2.073 L,ECW%分别为38.93%±1.10%、39.87%±1.00%、40.52%±1.32%、38.52%±0.95%.结论:在肝硬化初期患者即发生了水分分布异常,表现为ICW%降低,ECW%升高,ICW/ECW降低,并随肝功能恶化而加剧.
AIM:To investigate intracellular water(ICW) and extracellular water(ECW) distribution in patients with cirrhosis.METHODS:One hundred and four cirrhotic patients were divided into three groups based on Child-Pugh class(A,B,C),and 24 healthy volunteers were used as controls(N).Total body water(TBW),ICW and ECW were measured by multi-frequency bioelectrical impedance.ICW% was calculated as ICW/TBW × 100%,and ECW% as ECW/TBW × 100%.RESULTS:Intracellular and extracellular fluid distribution changed in patients with cirrhosis.With the increase in Child-Pugh class,ECW andECW% increased and ICW% and ICW/TBW decreased(ECW:13.011 ± 2.517 L,14.463 ± 2.720 L,14.587 ± 2.976 L vs 13.300 ± 2.073 L;ECW%:38.93% ± 1.10%,39.87% ± 1.00%,40.52% ± 1.32% vs 38.52% ± 0.95%;ICW%:61.07% ± 1.10%,60.03% ± 1.00%,59.48% ± 1.32% vs 61.48% ± 0.95%;ICW/ECW:1.571 ± 0.072,1.510 ± 0.063,1.470 ± 0.789,1.598 ± 0.065).CONCLUSION:Intracellular and extracellular fluid distribution has changed at the beginning of the disease in cirrhotic patients,which manifests as increased ECW and ECW% and decreased ICW% and ICW/TBW.
AIM:To investigate intracellular water(ICW) and extracellular water(ECW) distribution in patients with cirrhosis.METHODS:One hundred and four cirrhotic patients were divided into three groups based on Child-Pugh class(A,B,C),and 24 healthy volunteers were used as controls(N).Total body water(TBW),ICW and ECW were measured by multi-frequency bioelectrical impedance.ICW% was calculated as ICW/TBW × 100%,and ECW% as ECW/TBW × 100%.RESULTS:Intracellular and extracellular fluid distribution changed in patients with cirrhosis.With the increase in Child-Pugh class,ECW andECW% increased and ICW% and ICW/TBW decreased(ECW:13.011 ± 2.517 L,14.463 ± 2.720 L,14.587 ± 2.976 L vs 13.300 ± 2.073 L;ECW%:38.93% ± 1.10%,39.87% ± 1.00%,40.52% ± 1.32% vs 38.52% ± 0.95%;ICW%:61.07% ± 1.10%,60.03% ± 1.00%,59.48% ± 1.32% vs 61.48% ± 0.95%;ICW/ECW:1.571 ± 0.072,1.510 ± 0.063,1.470 ± 0.789,1.598 ± 0.065).CONCLUSION:Intracellular and extracellular fluid distribution has changed at the beginning of the disease in cirrhotic patients,which manifests as increased ECW and ECW% and decreased ICW% and ICW/TBW.
引文
1 谢渭芬.肝硬化腹水的诊断及鉴别诊断.中华肝脏病杂志2003;3:181-182
2 孙芳,周怡伦,刘靖,马丽洁,韩彬,沈洋,崔太根.多频生物电阻抗法评价血液透析患者体液分布.中国血液净化2009;8:375-378
3 Plauth M,CabréE,Campillo B,Kondrup J,Marchesini G,Schütz T,Shenkin A,Wendon J.ESPEN Guidelines on Parenteral Nutrition:hepatology.Clin Nutr 2009;28:436-444[PMID:19520466 DOI:10.1016/j.clnu.2009.04.019]
4 Barac-Nieto M,Spurr GB,Lotero H,Maksud MG.Body composition in chronic undernutrition.Am J Clin Nutr 1978;31:23-40[PMID:413427]
5 张德平,刘静民,郑秀瑷.人体水分测量技术综述.中国医学物理学杂志2012;29:3184-3187
6 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案.中华传染病杂志2001;19:56-62
7 于润江,朱蕾,王燕英.体液代谢的平衡与紊乱.第1版.北京:人民卫生出版社,2011:1-27
8 Kotoh K,Nakamuta M,Fukushima M,Matsuzaki C,Enjoji M,Sakai H,Nawata H.High relative fat-free mass is important for maintaining serum albumin levels in patients with compensated liver cirrhosis.World J Gastroenterol 2005;11:1356-1360[PMID:15761975]
9 Finn PJ,Plank LD,Clark MA,Connolly AB,Hill GL.Progressive cellular dehydration and proteolysis in critically ill patients.Lancet 1996;347:654-656[PMID:8596380 DOI:10.1016/S0140-6736(96)91204-0]
10 叶燕明,黄艳庆.30例肝硬化腹水合并低钠血症的治疗体会.医学理论与实践2008;21:1046-1047
11 Kawaguchi T,Taniguchi E,Itou M,Ibi R,Okada T,Mutou M,Shiraishi S,Uchida Y,Otsuka M,Umeki Y,Oriishi T,Hayabuchi H,Tanaka S,Takakura M,Sata M.Body cell mass is a useful parameter for assessing malnutrition and severity of disease in nonascitic cirrhotic patients with hepatocellular carcinoma or esophageal varices.Int J Mol Med 2008;22:589 -594[PMID:18949378]
12 Figueiredo FA,De Mello Perez R,Kondo M.Effect of liver cirrhosis on body composition:evidence of significant depletion even in mild disease.J Gastroenterol Hepatol 2005;20:209-216[PMID:15683423DOI:10.1111/j.1440-1746.2004.03544.x]
13 Figueiredo FA,Perez RM,Freitas MM,Kondo M.Comparison of three methods of nutritional assessment in liver cirrhosis:subjective global assessment,traditional nutritional parameters,and body composition analysis.J Gastroenterol2006;41:476-482[PMID:16799890 DOI:10.1007/s00535-006-1794-1]
14 邵茉莉,刘冰熔.肝硬化腹水形成机制的研究现状.世界华人消化杂志2013;21:160-165
15 刘江华.肝硬化腹水形成原因及治疗的临床体会.医学信息2011;24:145-146
2 孙芳,周怡伦,刘靖,马丽洁,韩彬,沈洋,崔太根.多频生物电阻抗法评价血液透析患者体液分布.中国血液净化2009;8:375-378
3 Plauth M,CabréE,Campillo B,Kondrup J,Marchesini G,Schütz T,Shenkin A,Wendon J.ESPEN Guidelines on Parenteral Nutrition:hepatology.Clin Nutr 2009;28:436-444[PMID:19520466 DOI:10.1016/j.clnu.2009.04.019]
4 Barac-Nieto M,Spurr GB,Lotero H,Maksud MG.Body composition in chronic undernutrition.Am J Clin Nutr 1978;31:23-40[PMID:413427]
5 张德平,刘静民,郑秀瑷.人体水分测量技术综述.中国医学物理学杂志2012;29:3184-3187
6 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案.中华传染病杂志2001;19:56-62
7 于润江,朱蕾,王燕英.体液代谢的平衡与紊乱.第1版.北京:人民卫生出版社,2011:1-27
8 Kotoh K,Nakamuta M,Fukushima M,Matsuzaki C,Enjoji M,Sakai H,Nawata H.High relative fat-free mass is important for maintaining serum albumin levels in patients with compensated liver cirrhosis.World J Gastroenterol 2005;11:1356-1360[PMID:15761975]
9 Finn PJ,Plank LD,Clark MA,Connolly AB,Hill GL.Progressive cellular dehydration and proteolysis in critically ill patients.Lancet 1996;347:654-656[PMID:8596380 DOI:10.1016/S0140-6736(96)91204-0]
10 叶燕明,黄艳庆.30例肝硬化腹水合并低钠血症的治疗体会.医学理论与实践2008;21:1046-1047
11 Kawaguchi T,Taniguchi E,Itou M,Ibi R,Okada T,Mutou M,Shiraishi S,Uchida Y,Otsuka M,Umeki Y,Oriishi T,Hayabuchi H,Tanaka S,Takakura M,Sata M.Body cell mass is a useful parameter for assessing malnutrition and severity of disease in nonascitic cirrhotic patients with hepatocellular carcinoma or esophageal varices.Int J Mol Med 2008;22:589 -594[PMID:18949378]
12 Figueiredo FA,De Mello Perez R,Kondo M.Effect of liver cirrhosis on body composition:evidence of significant depletion even in mild disease.J Gastroenterol Hepatol 2005;20:209-216[PMID:15683423DOI:10.1111/j.1440-1746.2004.03544.x]
13 Figueiredo FA,Perez RM,Freitas MM,Kondo M.Comparison of three methods of nutritional assessment in liver cirrhosis:subjective global assessment,traditional nutritional parameters,and body composition analysis.J Gastroenterol2006;41:476-482[PMID:16799890 DOI:10.1007/s00535-006-1794-1]
14 邵茉莉,刘冰熔.肝硬化腹水形成机制的研究现状.世界华人消化杂志2013;21:160-165
15 刘江华.肝硬化腹水形成原因及治疗的临床体会.医学信息2011;24:145-146