【作者】 韩明明；

【导师】 齐玉梅；

【作者基本信息】 天津医科大学 ， 营养与食品卫生学， 2011， 硕士

【摘要】 目的1.从能量平衡角度,评价通用系数法作为住院2型糖尿病患者能量供给方法的合理性。2.从底物水平上研究营养干预对住院2型糖尿病患者物质代谢的影响,为临床营养治疗提供参考依据。方法1.住院2型糖尿病患者能量供给量研究选择我院内分泌科2010.5～2011.3期间住院的2型糖尿病患者,共100例,男女各50例。均符合1999年WHO糖尿病诊断标准。所有患者根据BMI分为三组,正常体重组(18.5kg/m2≤BMI<24kg/m2,A组)、超重组(24 kg/m2≤BMI<28kg/m2,B组)和肥胖组(BMI≤28kg/m2,C组)。住院期间患者能量供给采用通用系数法,即按照单位理想体重计算基本能量供给量,再根据患者的年龄、性别和饮食习惯等进行调整。调整后实际能量供给量仍在20～30 kcal/kg IBW/d。蛋白质、脂肪和碳水化合物的比例分别按15%～20%、20%～30%和55%～60%供给。对所有患者进行间接能量测定获得REE,并分别比较不同组间住院2型糖尿病患者实际能量供给量与REE的差异。2.住院2型糖尿病患者营养干预研究选择我院内分泌科2010.9～2011.3期间住院的2型糖尿病患者9例为试验组。选择同期门诊2型糖尿病患者9例为对照组。试验组患者住院后即对其进行营养干预,能量供给采用通用系数法,即按照单位理想体重计算基本能量供给量,再根据患者的年龄、性别和饮食习惯等进行调整。调整后实际能量供给范围在20～30 kcal/kg IBW/d；蛋白质、脂肪和碳水化合物的比例分别按照15%～20%、20%～30%和55%～60%供给；营养干预10～12天。对照组仅给予饮食指导,未进行严格的营养干预。两组患者均接受药物治疗。试验组患者分别于干预前和干预后第10～12天进行两次空腹和餐后2h血糖、人体成分分析和间接能量测定。对照组患者为1个月内进行两次空腹和餐后2h血糖、人体成分分析和间接能量测定。比较两组患者前后两次空腹血糖、餐后2h血糖、去脂体重、体脂肪量、内脏脂肪面积、静息能量消耗、呼吸商、非蛋白呼吸商、24 h尿氮、蛋白质氧化率、脂肪氧化率和碳水化合物氧化率的改变情况。结果1.住院2型糖尿病患者能量供给量研究(1)基本资料100例2型糖尿病患者中,81例(81%)均为超重或肥胖。三组年龄、病史、身高等指标比较差异均无统计学意义。(2)血糖指标三组患者经过住院期间的治疗过程,空腹血糖、早餐后2 h、午餐后2h和晚餐后2h均较前有明显降低,差异均有统计学意义。(3)营养治疗量三组患者能量供给量差异均无统计学意义。三组患者平均能量供给量为(26.3±3.2)kcal/kg IBW。三组患者蛋白质、脂肪和碳水化合物供给比例比较差异均无统计学意义。(4)代谢率指标三组患者REE比较,差异有统计学意义(P=0.002),两两比较发现,A和B、C组比较差异均有统计学意义(P=0.009,P=0.001),而B和C组比较差异无统计学意义。但采用去脂体重进行校正后,三组间REE差异均无统计学意义。三组患者RQ、npRQ,24 h尿氮,蛋白质、脂肪和碳水化合物底物氧化率比较,差异均无统计学意义。(5)能量供给量与REE的比较A组患者能量供给量平均水平与REE比较,差异无统计学意义,能量供给量约是REE的1.05倍；B组患者能量供给量平均水平低于REE(P=0.000)约150 kcal,约为REE的0.92倍；C组患者能量供给量平均水平低于REE(P=0.000)约300 kcal,约为REE的0.84倍。2.住院2型糖尿病患者营养干预研究(1)基本资料两组患者年龄、性别、身高、体重和BMI比较,差异均无统计学意义。(2)血糖指标试验组患者干预后空腹血糖和餐后2h血糖均低于干预前,差异均有统计学意义(P=0.002,P=0.018)。对照组患者空腹血糖和餐后2h血糖干预后也低于干预前,差异均有统计学意义(P=0.037,P=0.010)(3)人体成分两组患者干预前、后去脂体重、体脂肪量、内脏脂肪面积分别比较,差异均无统计学意义。(4)代谢率指标干预后两组患者REE和单位去脂体重REE,分别与干预前比较,差异均无统计学意义。两组患者RQ和npRQ,干预前分别比较差异均无统计学意义,干预后分别比较差异均有统计学意义(P=0.044,P=0.038)。试验组干预前后RQ和npRQ分别进行比较,差异均有统计学意义(P=0.034,P=0.020)。对照组前后两次RQ和npRQ分别进行比较,差异均无统计学意义。两组患者蛋白质、脂肪和碳水化合物氧化率比较,干预后试验组碳水化合物氧化率高于对照组(P=0.042),而蛋白质和脂肪氧化率两组比较差异无统计学意义；试验组干预后碳水化合物氧化率高于干预前(P=0.044),蛋白质和脂肪氧化率前后比较差异无统计学意义。对照组干预前后比较,蛋白质、脂肪和碳水化合物氧化率均无统计学差异。结论1.采用通用系数法供给能量,从能量平衡角度来说,可以满足2型糖尿病患者达到理想体重或适宜体重的能量控制要求。2.采用通用系数法对2型糖尿病患者进行营养干预,可以改善糖尿病患者体内的糖利用障碍,从而在一定程度上纠正糖脂代谢紊乱状态。更多还原

【Abstract】 Objective1. To evaluate the rationality of general coefficient method to supply energy for hospitalized patients with type 2 diabetes, according to energy balance.2. To study the effect of nutrition intervention on substance metabolism of hospitalized patients with type 2 diabetes, on the level of substrate oxidation, as references for clinical nutrition therapy.Methods1. Study on energy supply in hospitalized patients with type 2 diabetesAll 100(50 men and 50 women) type 2 diabetes patients hospitalized in the Endocrinology between May 2010 and March 2011 were chosen,which were diagnosed according to diabetes diagnostic criteria of WHO in 1999. All the patients were divided into three groups according to BMI, which were normal body weight group (18.5 kg/m2≤BMI< 24 kg/m2, Group A), overweight group (24 kg/m2≤BMI< 28 kg/m2, Group B) and obesity group (BMI≥28 kg/m, Group C). In the duration of hospital stay, energy supply for patients was calculated by general coefficient method, from 20 to 30 kcal/kg ideal body weight, and the proportion of protein, fat and carbohydrate were from 15% to 20%,20% to 30% and 55% to 60%, respectively. REE were measured as soon as patients hospitalized by indirect calorimetry. And to study the differences between energy supply and REE in hospitalized patients with type 2 diabetes.2. Nutrition intervention study in hospitalized patients with type 2 diabetesNine type 2 diabetes patients hospitalized in the Endocrinology from September 2010 to March 2011 were chosen as test group. Nine type 2 diabetes outpatients in the same time were chosen as control group. In the test group, the energy supply was calculated by general coefficient method, from 20 to 30 kcal/kg ideal body weight. The proportion of protein, fat, and carbohydrate was 15% to 20%,20% to 30% and 55% to 60%, respectively. The test group was given nutrition intervention for 10 to 14 days, and the control group was given diet instruction, merely. The changes of fasting blood glucose,2-hours postprandial glucose, resting energy expenditure, respiratory quotient, non-protein respiratory quotient, substrate oxidization of protein, fat and carbohydrate of the two groups before and after intervention were compared.Results1. Study on energy supply in hospitalized patients with type 2 diabetes(1) Basic data Among the 100 type 2 diabetes,81 cases were overweight or fat. The differences of age, gender and height in three groups had no statistically significance.(2) Blood glucose index Fasting blood glucose,2-hours postprandial glucose were decreased after therapy in all three groups(P all was 0.000).(3) Nutrition therapy The differences of energy supply in three groups had no statistically significance.(4) Metabolic rate measurement index The differences of REE in the three type 2 diabetes groups had statistically significance(P=0.002).(5) Comparison of actual energy supply and REE In the normal weight type 2 diabetes, the actual energy supply is equal to REE; Overweight patients is less than REE (P=0.000) about 150 kcal; Obesity is less than (P=0.000) REE about 300 kcal.2. Nutrition intervention study in hospitalized patients with type 2 diabetes(1) Basic data Comparing the age, sex, body height, weight and BMI between the two groups, the differences had no statistically significance.(2) Blood glucose Fasting blood glucose,2-hours postprandial glucose were decreased after intervention in both two groups(P all was 0.000).(3) Metabolic rate measurement index REE had no statistically significance before and after intervention. In the test group, RQ and npRQ both had statistically significance before and after intervention (P=0.034,P=0.020),but not in control group.Conclusion(1) The general coefficient method for energy supply of type 2 diabetes is appropriate for weight maintenance.(2) Nutrition intervention can raise carbohydrate’s oxidization rate and respiratory quotient, which is helpful in correcting patients’metabolic disorder.更多还原