156例重症酒精性肝病患者营养现况调查  

Nutritional status of 156 patients with severe alcoholic liver disease

作　　者：翟庆慧 宋芳娇 徐天娇 曹丽巍 辛绍杰 刘婉姝 Zhai Qinghui;Song Fangjiao;Xu Tianjiao;Cao Liwei;Xin Shaojie;Liu Wanshu(Liver Failure Treatment and Research Center,Fifth Medical Center,PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝衰竭诊疗与研究中心,北京100039

出　　处：《中国肝脏病杂志（电子版）》2020年第1期44-49,共6页Chinese Journal of Liver Diseases：Electronic Version

基　　金：国家“十二五”科技重大专项(2012ZX10002004-005);国家“十三五”科技重大专项(2017ZX10203201-004);解放军总医院第五医学中心青年培育项目(QNPY2015001)。

摘　　要：目的调查重症酒精性肝病(severe alcoholic liver disease,SALD)患者营养风险发生率,为临床预防及治疗提供参考。方法采用横断面研究,对2016年1月至2018年6月解放军总医院第五医学中心收治的SALD患者进行营养风险筛查(NRS2002),根据NRS2002评分,将患者分为有营养风险组(总分≥3分)和无营养风险组(总分<3分)。记录患者身高和体质量,计算体重指数(body mass index,BMI),同时检测患者血清总胆红素(total bilirubin,TBil)、丙氨酸氨基转移酶(alanine aminotransfease,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)、凝血酶原活动度(prothrombin activity,PTA)、钠(Na)、钾(K)、钙(Ca)、铁(Fe)、镁(Mg)、维生素B12及叶酸水平,计算MELD评分,比较两组患者上述指标及腹膜炎、腹水、肝性脑病、食管胃底静脉曲张等并发症发生率的差异。对患者进行Child-Turcotte-Pugh(CTP)评分,比较不同CTP分级患者营养风险发生率。采用Log Rank(Mantel-Cox)比较患者生存率的差异。结果本研究共纳入156例SALD患者,其中有营养风险组113例,无营养风险组43例,营养风险发生率为72.44%。29例CTP A级患者中有营养风险者5例(17.24%);74例CTP B级患者中有营养风险者59例(79.73%);53例CTP C级患者中有营养风险者49例(92.45%)。有营养风险组和无营养风险组患者每日饮酒折合乙醇量(中位数:200.00 g vs 160.00 g)、住院时间[(17.53±9.43)d vs(11.05±5.96)d]、BMI [(23.76±3.32)kg/m2 vs(25.43±3.71)kg/m2]、MELD评分(中位数:7.98分vs 3.03分)、TBil(中位数:97.30μmol/L vs 24.70μmol/L)、ALP(中位数:142.00 U/L vs111.00 U/L)、ALT(中位数:29.00 U/L vs 37.00 U/L)、AST(中位数:54.00 U/L vs 51.00 U/L)、PA [(58.12±33.60)mg/L vs (147.09±75.72)mg/L]、ALB [(26.80±4.10)g/L vs(35.80±3.69)g/L]、PTA(中位数:45.10%vs 74.20%)、Na [(136.79±4.36)mmol/L vs(139.28±2.74)mmol/L]、Ca [(2.09±0.13)mmol/L vs(2.26±0.19)mmol/L]�Objective To investigate the incidence of nutritional risks of patients with severe alcoholic liver disease(SALD) and to provide reference for clinical prevention and treatment. Methods Patients with SALD in the Fifth Medical Center of PLA General Hospital from January 2016 to June 2018 were screened for nutritional risk(NRS2002) in this cross-sectional study. According to NRS2002 score, the patients were divided into nutrition risk group(total score ≥ 3) and non-nutrition risk group(total score < 3). The height and body mass of the patients was recorded, and body mass index(BMI) was calculated. Total bilirubin(TBil), alanine aminotransfease(ALT), aspartate aminotransferase(AST), prealbumin(PA), albumin(ALB), prothrombin activity(PTA), Na, K, Ca, Fe, Mg, vitamin B12 and folic acid levels were detected and the MELD scores were calculated. The difference of the above indexes and the incidence of complications including ascites, peritonitis, hepatic encephalopathy and esophageal and gastric fundus varices were compared between the two groups. Child-Turcotte-Pugh(CTP) scores were performed to compare the incidence of nutritional risk in patients with different CTP grades. Log Rank(Mantel-Cox) was used to compare the differences in the survival rate of the patients. Results Total of 156 patients with SALD were enrolled, including 113 cases in nutrition risk group and 43 cases in non-nutrition risk group, the incidence of nutrition risk was 72.44%. There were 5 cases with nutritional risk out of the 29 cases with CTP A grade(17.24%), 59 cases with nutritional risk out of the 74 cases with CTP B grade(79.73%) and 49 cases with nutritional risk out of the 53 cases with CTP C grade(92.45%). Daily ethanol intake(median: 200.00 g vs 160.00 g), length of hospital stay [(17.53 ± 9.43) d vs(11.05 ± 5.96) d], BMI [(23.76 ± 3.32) kg/m2 vs(25.43 ± 3.71) kg/m2], MELD score(median: 7.98 vs 3.03), TBil(median: 97.30 μmol/L vs 24.70 μmol/L), ALP(median: 142.00 U/L vs 111.00 U/L), ALT(median: 29.00 U/L vs 37.00 U/L), AST(media

关 键 词：肝病 重症 酒精性 营养风险筛查 

分 类 号：R575.5[医药卫生—消化系统]