2型糖尿病患者的静息能量消耗及底物氧化利用研究

摘要

目的:研究2型糖尿病患者不同糖化血红蛋白(HbAlc)水平的静息能量消耗(REE)及蛋白质、脂肪和碳水化合物的氧化利用情况,了解其物质、能量代谢特点.方法:随机选择住院2型糖尿病患者86例,根据HbAlc水平分为3组,HbAlc≤7%为A组、7%～9%为B组和≥9%为C组,同时选择门诊健康体检者20例作为对照组,采用间接测热法检测REE、呼吸商(RQ)、非蛋白呼吸商(npRQ)及蛋白质、脂肪和碳水化合物氧化利用率,并进行组间比较;另外,REE采用体重和体表面积分别进行校正.结果:糖尿病实测REE高于对照组,约12.3%,但只有B组与对照组比较有统计学差异.经体重或体表面积校正后,糖尿病各组REE/体重或REE/体表面积均高于对照组(P＜0.05).不同HbAlc水平组间实测REE、REE/体重和REE/体表面积均无差异.各组RQ和npRQ均值为0.80～0.82.脂肪氧化所占比例为48.90%～52.50%,高于碳水化合物和蛋白质.糖尿病各组脂肪氧化率较对照组高,且随HbAlc升高而升高,而碳水化合物氧化率随HbAlc升高而降低,但均无统计学差异.结论:糖尿病患者具有较高的静息代谢率;HbAlc指标不能真实反映REE水平;糖尿病组呼吸商较低、脂肪氧化率较高,可能与糖尿病患者存在糖氧化受阻、脂肪氧化作用增强有关.%Objective: To investigate the resting energy expenditure (REE), oxidative utilization rate of protein, fat and carbohydrate in type 2 diabetic patients with different glycosylated hemoglobin Alc(HbAlc ) levels and understand the metabolic characteristics of substance and energy in diabetic patients. Methods: Eighty-six type 2 diabetic patients in hospital, who selected at random, were divided into three groups according to HbA1c levels, i.e. HbAlc≤7％ group (Group A), 7％ to 9％ group (Group B) and ≥9％ group (Group C).Twenty health examination people in clinic service were collected as the control group at random. REE, respiratory quotient (RQ), nonprotein respiratory quotient (npRQ)and oxidative utilization rate of protein, fat and carbohydrate were detected by indirect calorimetry,and REE was corrected by body weight and body surface area. Results: Real REE value was about 12.3 ％ higher than that in control group, with significant difference between Goup B and control group. When REE corrected by body weight and body surface area, all of the three diabetic groups were higher than that in control group(P＜O.05 ), but there was no significant difference among the three diabetic groups. The mean value of both RQ and npRQ was about 0.80 to 0.82. Fat oxidative rate had the highest ratio in three energy nutrients,with the mean value 48.90％ to 52.50％, followed by carbohydrate and protein. Fat oxidation rate was higher in three diabetic groups than that in control group; with the higher HbAlc level, the fat oxidation rate was' higher and the carbohydrate rate was lower, but no significant difference among the groups. Conclusion: Resting energy metabolism levels is higher in type 2 diabetic patients. HbA1c levels can not be used to reflect the changes of REE in different individuals. Low respiratory quotient value and high fat oxidation rate in diabetic groups may hint decreased glucose oxidation effect and increased fat oxidation effect.