Study On Characteristics Of Energy And Protein Metabolism And Protein Supply For Liver Cirrhosis

Objective1. The aim of this study was to evaluate the characteristics of the energy and protein metabolism for liver cirrhosis patients, using indirect calorimetry and other markers.2. To study the effect of different levels of protein on the nutritional status and liver and kidney function, then provide a reference of adequate protein procision for patients with liver cirrhosis.Methods1. Study on characteristics of energy and protein metabolism in liver cirrhosis patients All77(47male and30female) subjects were selected from liver cirrhosis patients hospitalized in the department of Gastroenterology from August2010to February2012. which were met the diagnostic criteria proposed of the "Symposium on Viral Hepatitis and Liver Diseases in2000". All the patients were divided into three groups according to the Child-pugh classification. The REE and the protein, fat and carbohydrate oxidation rates were determined by indirect calorimetry. Anthropometric measurements, body composition analysis and laboratory testing were also determined to evaluate the characteristics of the energy and protein metabolism in liver cirrhosis patients.2. Study on the levels of protein supply for cirrhosis ratsA total of60healthy male Wistar rats were divided randomly into four groups: normal group(group A), low protein group(group B), standard protein group(group C) and high protein group(group D). Cirrhosis rat model was established by CCl4and alcohol. Supply different levels of protein to relevant groups. Serum samples and liver and kidney tissue were collected before and after6weeks’diet interventions respectively to detect the liver function and someother indicators.Results1. Study on characteristics of energy and protein metabolism in liver cirrhosis patients(1) Metabolic rate measurement index The REE of cirrhosis patients were higer than control group(P<0.05). and their fat oxidation rate was increased. (2) Anthropometry After removal of the weight and gender impact factors, the grip of the control group was higher than in cirrhosis patients(P<0.05).(3) Body composition analysis The body protein, fat-free mass, muscle mass and skeletal muscle mass of control group were higher than in cirrhosis patients(P<0.05).(4) The serum indicators Compared with control group, levels of the total protein, albumin and prealbumin of cirrhosis patients were decreased(.P<0.01).(5) Dietary survey The total diet calories, protein, fats and carbohydrate were decreased and the differences are statistically significant (P＜0.05).2. Study on the levels of protein supply for cirrhosis rats(1) Nutritional status The model group rats were activity reduced and food intake decreased. The activity and food intake were improved after the intervention.(2) Liver and renal pathological changes Light-microscopy measurement:there were pseudolobule in the model rats. There was no obvious change in cirrhosis rats after intervention. There was enlarged kidney glomerulus by chance while no pathological changes were found in the kidney of control group.(3) Organ index The liver index in group S were lower than in group N and group L while the kidney index in group S and H were higher than in group A and group B. and the differences were statistically significant (P<0.05).(4) Liver and renal function Compared with control group, the TP and ALB were decreased while ALT and AST were increased in cirrhosis rats; ALT AST albumin and retinol binding protein were all decreased after intervention and the differences were statistically significant (P<0.05).(5) The immune function Compared with control group, the IL-10and IGF-1were decreased while TNF-a was increased in cirrhosis rats; the IL-10. IGF-1and TNF-a were increased after intervention; and the differences were statistically significant (P＜0.05).(6) Oxidative stress function Compared with the control group, serum MDA and SOD were decreased after intervention, and the differences were statistically significant (P＜0.05).(7) Nitrogen balance Group L cirrhosis rats were in negative nitrogen balance before intervention and other groups were in positive nitrogen; the four groups of rats were in positive nitrogen balance, in which the group H of nitrogen balance was higher than the other three groups, and the differences were statistically significant (P＜0.05).(8) Urinary albumin The urine albumin in group S and H were higher than in group N and group L, and the differences were statistically significant (P<0.05).Conclusion1. Patients with live cirrhosis were in high metabolic status. They use fat as the main fuel for oxidation. The extent of carbohydrates inhibition and severity of cirrhosis was positively correlated. The Child-Pugh class B cirrhosis patients showed protein protective effect and the mechanism in Child-Pugh class C was broken.2. Energy and protein intakes in these patients were inadequate. Most of them showed energy-protein malnutrition.3. Provision of different levels of protein for rats with cirrhosis can affect stress status, immune function and nutritional status differently. Among these three levels, medium and low levels show better effects, which can improve liver function, immune function and nutritional status.