RFH-NPT与NRS2002在肝硬化住院患者营养风险筛查中的比较研究  

COMPARISON OF RFH-NPT AND NRS2002 FOR NUTRITIONAL RISK SCREENING IN LIVER CIRRHOSIS INPATIENTS

作　　者：肖慧娟 叶青[3] 齐玉梅[2] 张明[2] 韩涛[1,3,4,5,6] 王昕[2] XIAO H ui-juan;YE Qing;Q IY ue-mei;ZHANG Ming;HAN Tao;WANG X in(The Third Centre Clinical College, Tianjin Medical University;Department of Nutrition,The Third Central Hospital of Tianjin, Tianjin 300170;Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin 300170;Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170;Tianjin Key Laboratory of Artificial Cell, Tianjin, 300170;Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, 300170, China)

机构地区：[1]天津医科大学三中心临床学院,天津300170 [2]天津市第三中心医院营养科,天津300170 [3]天津市第三中心医院消化(肝病)科,天津3001704 [4]天津市肝胆疾病研究所,天津300170 [5]天津市人工细胞重点实验室,天津300170 [6]卫生部人工细胞工程技术研究中心,天津300170

出　　处：《营养学报》2019年第3期257-260,264,共5页Acta Nutrimenta Sinica

基　　金：十三五科技重大专项子课题(No.2017ZX10203201007)

摘　　要：目的将RFH-NPT应用于肝硬化住院患者营养风险筛查中,并与NRS-2002进行比较,筛选出更适合肝硬化患者营养风险筛查的工具。方法收集肝硬化住院患者152例,进行人体测量、生化检查、人体成分分析,采用RFH-NPT和NRS-2002工具进行营养风险筛查评分。结果 RFH-NPT与NRS-2002营养风险筛查结果具有一致性(Kappa=0.605,P <0.001),在肝功能Child-pugh分级各组患者中的筛查结果均表现一致;随着肝功能进展,营养风险逐渐升高;前者筛查阳性率明显高于NRS-2002(87.5%v.s. 78.9%,P=0.002),尤其以Child C级肝功能患者为著(100%v.s.77.3%)。根据RFH-NPT评分,有营养风险的肝硬化患者握力(GS)、上臂肌围(AMC)、细胞内水分(ICW)、细胞外水分/全身总水分含量(ECW/TBW)、身体细胞量(BCM)均明显低于无营养风险患者,且差异有统计学意义(P <0.01);RFH-NPT评分与ECW/TBW成正相关,与白蛋白(ALB)、前白蛋白(PA)、GS、AMC成负相关关系;并发症胸/腹腔积液、食管-胃底静脉曲张(破裂出血)是肝硬化患者发生营养风险的危险因素,而BCM是保护因素。结论 RFH-NPT是一种适合肝硬化患者的营养风险评估工具,可能优于NRS-2002,但尚需进一步研究证实以便于推广应用;GS、AMC、BCM、并发症与肝硬化患者的营养风险关系密切,影响患者的临床预后。Objective To apply RFH-NPT for nutritional risk screening in patients with cirrhosis compare it with NRS-2002. Methods A total of 152 inpatients with liver cirrhosis were included in the study. Anthropometric and laboratory parameters, body composition were measured. BMI and AMC were calculated according to the data obtained. RFH-NPT and NRS-2002 were used to assess the nutritional risk of the patients. Results The results of nutritional risk screening by RFH-NPT and NRS-2002 were consistent(Kappa=0.605, P<0.001). They showed the same consistency in different groups. With the progress of liver dys function, nutritional risk increased;the positive rate of screening by RFH-NPT was significantly higher than that by NRS-2002 (87.5% v.s. 78.9%, P=0.002), especially in child C group. According to the RFH-NPT score, grip strength(GS), arm muscle circumference(AMC), intracellular cell water (ICW), extracellular cell water/total body water (ECW/TBW) and body cell mass (BCM) of patients with nutritional risk were significantly lower than those of patients without nutritional risk (P<0.01). The RFH-NPT score was positively correlated with ECW/TBW, but negatively with albumin (ALB), prealbulmin (PA), GS, and AMC. The complications such as thoracic/ascites, esophageal and gastric varices (rupture) were risk factors for the patients with nutritional risk, whereas BCM was a protective factor.Conclusion RFH-NPT is an appropriate tool of nutritional risk screening for the cirrhotic patients. It may be better than NRS-2002. GS, AMC, BCM, and complications were closely correlated with nutritional risk in patients with liver cirrhosis and affected their prognosis.

关 键 词：肝硬化 营养风险筛查 RFH-NPT NRS-2002 

分 类 号：R459.3[医药卫生—治疗学]