营养干预对有营养风险的肝硬化患者预后的影响

目的评价个体化的营养干预对有营养风险肝硬化患者预后的影响。方法选择2013年1～7月北京佑安医院人工肝中心收治的78例有营养风险的住院肝硬化患者,随机分为干预组（40例）和对照组（38例）,以实际体重占理想体重百分比、肱三头肌皮褶厚度（TSF）及上臂肌围（AMC）评价其营养状况,并对干预组进行个体化的营养干预。记录患者的体质指数（BMI）、握力、白蛋白、前白蛋白、淋巴细胞计数、入院时和出院时的肝功能Child-Pugh分级、并发症情况和出院转归。结果干预组出院时的白蛋白、前白蛋白水平升高值明显高于对照组,差异均有统计学意义（3.3±2.1）g/L vs.（1.4±4.7）g/L,P=0.023;（39.4±20.7）mg/L vs.（-0.6±24.4）mg/L,P〈0.0001]。干预组入院时Child-Pugh A、B、C分级依次为9例（22.5%）、18例（45.0%）、13例（32.5%）,出院时依次为17例（42.5%）、15例（37.5%）、8例（20.0%）,差异有统计学意义（P=0.001）。干预组的并发症发生率低于对照组（10.0%vs.31.6%,P=0.013）,其病死率也低于对照组（2.5%vs.21.1%,P=0.018）。结论有营养风险的肝硬化患者临床预后较差,积极进行营养干预可改善其预后。

The effect of nutritional intervention on the prognosis in the liver cirrhosis patients with nutritional risk

Objective To investigate the effection of individualized nutritional intervention on the prognosis in cirrhosis patients with nutritional risk. Methods Seventy-eight patients who had nutritional risk with liver cirrhosis were enrolled and randomly divided into intervention group（n=40） and control group（n=38）. The ratio of actual body weight/ideal body weight, triceps skinfold（TSF）, and mid arm muscle circumference（AMC） were used to evaluate the nutritional status.Individual nutritional intervention was given for intervention group. Body mass index（BMI）, power of gripping, albumin and prealbumin level, lymphocyte count, Child-Pugh stage when admitted and discharged, complications, and outcome were recorded. Results The difference value of serum albumin and prealbumin when admitted and discharged in the intervention group were higher than the control（3.3±2.1）g/L vs.（1.4±4.7） g/L, P = 0.023;（39.4±20.7） mg/L vs.（-0.6±24.4） mg/L,P〈0.0001]. In the intervention group, the constitution of Child-Pugh stage A,B,C（42.5%, 37.5%, 20.0%） when the patients discharged improved significantly than admitted（22.5%, 45.0%, 32.5%, P = 0.001）. Both of the ratio of complication（10.0% vs. 31.6%, P = 0.013）and mortality（2.5% vs. 21.1%, P = 0.018） in the intervention group were lower than the control. Conclusion The prognosis of liver cirrhosis patients with nutritional risk is not good, nutritional intervention is helpful to prognosis.