广西医学

目的分析不同体质指数的非酒精性脂肪性肝病（NAFLD）患者的心功能及三大底物消耗特点。方法选取45例NAFLD患者，根据体质指数将其分为正常组（15例）、超重组（13例）和肥胖组（17例）。采用心肺运动试验（CPET）测定3组患者在运动达无氧阈时及达最大运动时的摄氧量、碳水化合物能量消耗、脂肪能量消耗、蛋白质能量消耗。采用Weber心功能评级标准评估3组患者的心功能进行评定。结果 3组患者Weber心功能分级均为B级。达最大运动时，正常组、超重组、肥胖组患者的摄氧量依次降低（P<0.05）；运动达无氧阈时，肥胖组患者的碳水化合物能量消耗高于超重组和正常组（P<0.05），但超重组和正常组之间差异无统计学意义（P˃0.05）；运动达无氧阈时，正常组、超重组、肥胖组患者的蛋白质能量消耗依次增加（P<0.05）。但运动达无氧阈和最大运动时，3组患者的脂肪能量消耗差异无统计学意义（P˃0.05）。结论 NAFLD患者均存在轻度至中度心功能损害。在进行较高强度运动时，体质指数越大的NAFLD患者的摄氧能力越低，心脏运动耐力越差；在进行中低强度运动时，高体质指数的NAFLD患者所需能量倾向于由碳水化合物代谢和蛋白质代谢提供；无论运动强度高低，NAFLD患者的脂肪氧化代谢能量消耗基本不受体质指数影响。

Objective To analyze the cardiac function and consumption characteristics of three major substrates in patients with non⁃alcoholic fatty liver disease (NAFLD) with different body mass indexes. Methods A total of 45 NAFLD patients were selected, and they were divided into normal group (15 cases), overweight group (13 cases), or obesity group (17 cases) according to body mass index. Cardiopulmonary exercise testing (CPET) was used to measure oxygen uptake, consumption of carbohydrate energy, and consumption of fat energy and protein energy when exercise reached anaerobic threshold and maximum. Cardiac function of patients in the three groups was assessed by employing the Weber cardiac function classification standard. Results The Weber cardiac function classification of patients in the three groups was class B. When exercise reached maximum, oxygen uptake was decreased successively in the normal, overweight, and obesity groups (P<0.05). When exercise reached anaerobic threshold, the obesity group exhibited higher consumption of carbohydrate energy as compared with the overweight and normal groups (P<0.05), but there was no statistically significant difference between the overweight group and the normal group (P˃0.05). When exercise reached anaerobic threshold, consumption of protein energy was increased successively in the normal, overweight and obesity groups (P<0.05), but there was no statistically significant difference in consumption of fat energy between the three groups when exercise reached anaerobic threshold and maximum (P˃0.05). Conclusion NAFLD patients suffer from mild to moderate cardiac function damage. During higher exercise intensity, NAFLD patients with greater body mass index have lower oxygen uptake capacity and poorer cardiac exercise tolerance, and when performing moderate to low exercise intensity, NAFLD patients with high body mass index tend to require energy provided by carbohydrate metabolism and protein metabolism; in addition, regardless of exercise intensity, energy consumption of fat oxidation metabolism in NAFLD patients is basically not affected by body mass index.