肺気腫患者のエネルギー代謝に関する研究

Abstract

Resting energy expenditure (REE) in 21 ambulatory stable outpatients with pulmonary emphysema (age: 70.5±8.4, %IBW: 77.9±12.5, FEV1.0: 0.98±0.36) was evaluated and compared with that of in 14 age-matched senior healthy controls (age : 71.6 ±6.0, %IBW : 94.5±13.4), and with that of 12 younger adult healthy controls (age : 29.8 ±5.1, %IBW : 92.4±6.0). REE in malnourished patients (%IBW<90 ; 73.0±7.6, N=14) was compared with that of normonourished patients (%IBW≧90 ; 92.0±5.6, N=7). The effects of supplementary nutritional therapy with BCAA enriched elemental diet in addition to usual diet in 4 malnourished patients (total calorie: REE×1.7, term: 9±4.5 months) also was assessed. The mean value of REE in age-matched controls was significantly lower than that in younger controls (%REE, i.e. REE/REE pred. ×100;86.5±8.7 vs 97.8±13.5, p<0.05). The mean value of REE in the patient group was significantly higher than those in the 2 control groups (%REE ; 115.9±12.0, p<0.01, respectively). The mean value of REE in the malnourished patients was significantly higher than that in the normonourished patients (121.9±7.9 vs 109.1±9.2, p<0.01). There were no significant differences in lung function tests between the two patient groups. The mean value of REE in the normonourished patients was even significantly higher than that in age-matched controls (p<0.01). There were signiaicant correlations found between %REE and FEV1.0, %FVC, FEV1.0%, %DLco/VA and RV/TLC% in 21 emphysema patients by using single regression analysis (p<0.05). Improvement in nutritional status of 4 malnourished patients was found in terms of BW, %IBW, TSF, GS and Fischer ratio of plasma amino acids, but REE/kg after nutri- tional therapy was lower than that befere the therapy (26.0±3.5 vs 28.5±1.8, p=0.19, paired t-test). These results indicate thet hypermetabolism and lung function are closely correlated in emphysema patients, and that appropriate supplementary nutritional therapy might have a significant effect on dinadvantageous hypermetabolism in terms of improvement of body weight and efficiency of ventilation.