慢性病毒性肝炎肝硬化合并慢性肾脏病病人的营养状况分析  

Analysis of nutritional status in patients with chronic viral hepatitis cirrhosis complicated with chronic renal disease

作　　者：王小琪[1] 于淑清[1] 马列清[2] WANG Xiao-qi;YU Shu-qing;MA Lie-qing(Department of Dietetics;Department of hepatology and nephropathy,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院营养科,北京100069 [2]首都医科大学附属北京佑安医院肝病肾病科,北京100069

出　　处：《肠外与肠内营养》2018年第4期234-237,共4页Parenteral & Enteral Nutrition

摘　　要：目的:分析慢性病毒性肝炎肝硬化与慢性病毒性肝炎肝硬化合并慢性肾脏病(CKD)病人的营养状况。方法:选择慢性病毒性肝炎肝硬化病人105例,按是否合并CKD分为肝硬化组和肝硬化合并CKD组,记录入院时病人的性别、年龄、肝病病程、肾病基础疾病、肝功能Child-Pugh分级、血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞(L)绝对值、肾功能指标,体重指数(BMI)、三头肌皮褶厚度(TSF)、握力、欧洲营养风险筛查2002(NRS 2002)和主观整体评估(SGA)法对病人进行营养筛查与评估。结果:肝硬化组与肝硬化合并CKD组化验指标ALB、HB明显低于正常,两组间比较具有统计学意义;应用BMI、握力、TSF测量评价病人营养状况时,肝硬化组与肝硬化合并CKD组之间无统计学意义。肝硬化组与肝硬化合并CKD组应用NRS 2002营养风险发生率分别为32.81%和65.85%,两组间比较有统计学意义,尤其在Child-Pugh B级和C级病人;SGA评估营养不良发生率分别为28.12%和58.54%,两组间比较有统计学意义,但只在Child-Pugh B级病人有显著性差异。结论:合并CKD的肝硬化病人,营养风险发生率升高,随着肝硬化疾病的进展,营养风险及营养不良发生率进一步升高。Objective： To analyze the nutritional status of patients with chronic viral hepatitis cirrhosis and chronic viral hepatitis cirrhosis complicated with chronic Kidney Disease（CKD）. Method： There were 105 patients with chronic viral hepatitis cirrhosis which was divided into cirrhosis group and cirrhosis with CKD group. The gender, age, liver disease course, basic disease of kidney disease, Child-Pugh classification of liver function, serum albumin（ALB）, prealbumin（PA）, hemoglobin（Hb）, lymphocyte（L）, renal function were recorded at admission. Nutrition screening and assessment of patients was performed using body mass index（BMI）, triceps skinfold Thickness（TSF）, grip strength, the European Nutritional Risk Screening 2002（NRS2002） and subjective overall assessment（SGA） methods. Results：The values of ALB and HB were significantly lower than normal in patients with cirrhosis and cirrhosis complicated with CKD, and the comparison between the two groups was statistically significant. There was no significant difference between cirrhosis group and cirrhosis with CKD group according to BMI, grip strength and TSF. The comparison was statistically significant between two groups according NRS2002 which was 32.81% and 65.85% respectively, especially in Child-Pugh Class B and C patients. The incidence of malnutrition according to SGA was 28.12% and 58.54%, respectively, which was statistically significant, but only significant differences in Child-Pugh B patients. Conclusion： Patients with cirrhosis complicated with CKD can lead to an increased incidence of nutritional risk. As cirrhosisprogresses, the nutritional risk and malnutrition increases.

关 键 词：肝硬化 慢性肾脏病 营养 

分 类 号：R512.6[医药卫生—内科学]