慢性肝病患者的营养风险评估  

Nutritional risk assessment in patients with chronic liver disease

作　　者：时淑云[1] 韩军军[1] 闫茗[1] 王克菲[1] 于红卫[1] 孟庆华[1] 

机构地区：[1]首都医科大学附属北京佑安医院重症肝病科,100069

出　　处：《中华肝脏病杂志》2014年第7期536-539,共4页Chinese Journal of Hepatology

基　　金：佑安肝病艾滋病基金科研课题（BJYAH2011084）;首都医学发展科研基金（2009-3159）

摘　　要：目的 应用欧洲营养风险筛查方法（NRS-2002）探讨不同程度肝病住院患者存在的营养风险,评估NRS-2002应用于肝病患者的可行性. 方法 对366例患者进行营养风险调查,符合NRS-2002评定标准者于入院当天进行营养风险评分,NRS-2002≥3分者判定为存在营养不良风险,以体质量指数（BMI）小于18.5 kg/m2,判定为营养不良;不符合NRS-2002评定标准的,于入院次日清晨留血检测血清白蛋白,白蛋白＜35 g/L者判定为营养不良.计数资料以相对数表示,组间比较采用x2检验. 结果 210例患者适用于NRS-2002,其总营养风险发生率为41.0％,营养不良总发生率为7.6％,其中以肝衰竭营养风险发生率最高（72.8％）,97例肝硬化Child-Pugh A、B级患者营养风险发生率分别为33.1％、88.6％（x2=24.019,P=0.000）,不同病因患者,其营养风险发生率以酒精性相关肝病最高（66.7％）;不能应用NRS-2002的156例患者总营养不良发生率为76.2％. 结论 NRS-2002对肝病早期及轻症患者具有一定的适用性,但易出现假阳性,NRS-2002应用于终末期肝病患者存在局限性.Objective To use the European Nutritional Risk Screening （NRS）-2002 survey tool to investigate nutritional risk associated to different degrees of liver disease and to assess its ability to identify the nutritional risk of hospitalized patients with chronic liver disease.Methods A total of 366 hospitalized patients were assessed with the NRS-2002 on the day of admission.Patients who meet the criteria for malnourishment （NRS-2002 score of〉3 points （severely impaired nutritional status with body mass index （BMI） 〈 18.5 kg/m2） were selected for further study to deteemine liver function.Patients were classified according to liver dysfunction-related features,including cirrhosis status,Child-Pugh classification,and underlying disease causes （e.g.alcohol,hepatitis virus infection）.Chi square test was used in statistical analysis of inter-group difference.Results The incidence of patients surveyed who were at nutritional risk was 41.0%,and the incidence of malnutrition was 7.6%.The patients with liver failure showed the highest rate of nutritional risk （72.8%）.Moreover,among the 97 patients with liver cirrhosis,significantly more had Child-Pugh grade B than grade A （88.6% vs.33.1%;x2 =24.019,P =0.000）.The cause of liver failure with the highest incidence of nutritional risk was alcohol-related liver disease （66.7%）.The overall malnutrition rate among the total 156 patients classified by the NRS-2002 as being at nutritional risk was 76.2%.Conclusion The NRS-2002 is a suitable screening tool for use in Chinese patients with mild early liver disease,but it must be interpreted carefully as its findings alone may promote a false positive rate.The NRS-2002 is less accurate in patients with end-stage liver disease.

关 键 词：肝病 慢性 营养风险 NRS-2002 

分 类 号：R575[医药卫生—消化系统]