北京地区住院肝病患者营养风险的状况  

Prevalence of nutritional risk among in-patients with liver diseases in Beijing~ China

作　　者：郭会敏[1] 周莉[1] 马文晨[1] 朱彦涛[1] 王燕[1] 王静[1] 孙晓玲[1] 张长青 段钟平[1] 

机构地区：[1]首都医科大学附属北京佑安医院人工肝中心,北京100069 [2]开封市第六人民医院

出　　处：《中华肝脏病杂志》2013年第10期734-738,共5页Chinese Journal of Hepatology

基　　金：国家“十二五”重大科技专项（2012ZX10002004-006）;北京市科技新星计划（Z121107002512056）;首都医科大学重点实验室2012年度开放课题（2012GYGA01）

摘　　要：目的 目前对我国住院肝病患者营养状况的了解不多.本研究拟调查住院肝病患者的营养风险及营养不良发生率,分析其营养风险和预后的关系,为进一步临床干预提供参考信息. 方法 选取我院人工肝中心2012年4月至2012年12月住院的肝病患者331例,用实际体质量占理想体质量百分比、三头肌皮褶厚度（TSF）及上臂肌围（MAMC）评价其营养状况.用营养风险筛查2002表评估患者营养风险.同时记录患者的体质量指数、握力、白蛋白、前白蛋白、淋巴细胞计数、住院天数、住院期间并发症隋况、有无酗酒史和出院转归.对存在肝硬化的患者记录其入院时和出院时的肝功能Child-Pugh分级.均值比较用t检验,率的比较用x2检验或Firsher’s精确检验.结果 入院时有营养风险的患者共有113例,占34.1％,其中慢性肝炎组有营养风险的比例最低,为17.02％；慢加急性肝衰竭组有营养风险的比例最高,达56.52％.用TSF和MAMC评价患者营养状况,其总体营养不良发生率分别为36.9％和38.7％.有营养风险的肝硬化/肝癌患者中Child-Pugh分级C级的比例显著高于无营养风险的患者.有酗酒史的患者,用TSF评价其营养状况,存在营养不良的比例高于无酗酒史的患者.有营养风险者的体质量指数及握力、入院时的白蛋白、前白蛋白及淋巴细胞计数均低于无营养风险者,平均住院天数、并发症的发生率、死亡比例均明显高于无营养风险者. 结论 目前北京地区住院肝病患者有较高比例的营养风险及营养不良状态.TSF、MAMC均可用于评估住院肝病患者的营养状态.经营养风险筛查2002评估为有营养风险的肝病患者,其临床预后较差,需要积极进行营养干预.Objective To investigate the prevalence of nutritional risk and malnutrition among inpatients with liver diseases in Beijing,China,and to evaluate the relationship between nutritional risk and prognosis.Methods A total of 331 in-patients with liver diseases under care at the Artificial Liver Center of Beijing Youan Hospital were consecutively enrolled for study between April 2012 and December 2012.Nutritional status was determined by calculating each patient＇s ratio of real weight to clinically ideal weight,the triceps skin fold （TSF）,and the mid-upper arm muscle circumference （MAMC）.Nutritional risk was estimated using the Nutritional Risk Screening questionnaire 2002 （NRS-2002）.In addition,each patient＇s Child-Pugh stage,body mass index （BMI）,power of gripping,serum albumin and pre-albumin levels,lymphocyte count,hospital length of stay,complications,alcoholism history,and outcome after discharge were recorded for analysis.Results One-hundred-and-thirteen of the patients （34.1%） were defined as at nutritional risk upon hospital admission.The ratio of nutritional risk was lowest in patients with chronic hepatitis （17.0%） and highest in patients with acute on chronic liver failure （56.5%）.The ratios of malnutritionevaluated by TSF and MAMC were 36.9% and 38.7%,respectively.Among the patients with liver cirrhosis or hepatocellular carcinoma,the ratio of Child-Pugh stage C was higher for individuals defined as at nutritional risk than for those without.When TSF-based ratio of malnutrition was higher for individuals with a history of alcoholism than for those without.BMI,power of gripping,serum albumin level,serum pre-albumin level,and lymphocyte count were all lower for individuals defined as at nutritional risk than for those without.Hospital stay,ratio of complication onset,and ratio of death were all higher for individuals defined as at nutritional risk than for those without.Conclusion TSF and MAMC can be used to evaluate the nutritional status of in-patients with liver diseases.

关 键 词：肝疾病 营养调查 营养不良 

分 类 号：R575[医药卫生—消化系统]