不同营养评价方法与肝硬化腹水患者肝功能分级关系研究  

Analysis of the relationship between different nutritional evaluation methods and liver function classification in the patients with cirrhosis and ascites

作　　者：李海燕[1] 张瑞[1] 邵盼 郝晓静 Li Haiyan;Zhang Rui;Shao Pan;Hao Xiaojing(Department of Hepatology,Fuyang Second People′s Hospital,Fuyang 236015,China)

机构地区：[1]阜阳市第二人民医院肝病科,安徽阜阳236015

出　　处：《海军医学杂志》2020年第3期308-311,共4页Journal of Navy Medicine

基　　金：安徽省自然科学基金青年项目(1608085QH172)。

摘　　要：目的分析不同营养评价方法与肝硬化腹水患者肝功能分级的关系,筛选最适方法。方法提取2018年1月至2019年6月于阜阳市第二人民医院接受治疗的93例肝硬化腹水患者病历资料,根据Child-Pugh肝功能分级标准将其分为A级组(n=24)、B级组(n=26)、C级组(n=43),分别采用主观全面评定(subjective global assessment,SGA)法、微型营养评定(mini nutritionaal assessment,MNA)、营养风险筛查(nutritional risk screening,NRS)2002方法及各相关指标方法[体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thickness,TSF)、上臂肌围(upper arm muscle circumference,AMC)、血清白蛋白(serum albumin,ALB)、前白蛋白(prealbumin,PA)、淋巴细胞总数(total lymphocyte count,TLC)]评价3组患者营养状况,绘制ROC曲线,分析各方法与肝功能分级关系。结果3组BMI方法比较无差异(P>0.05);C级组SGA、ALB、PA法与B、A级组,其MNA、NRS 2002、TSF、AMC、TLC与A级组均存在差异(P<0.05);B级组SGA、MNA、TSF、ALB与A级组存在差异(P<0.05)。ROC曲线结果显示SGA、MNA、NRS2002、TSF、AMC、ALB、PA、TLC营养评价方法用于预测肝硬化腹水肝功能分级的曲线下面积分别为0.888、0.787、0.722、0.685、0.414、0.768、0.671、0.675,其中SGA预测价值最高。结论肝硬化腹水患者肝功能分级的有效营养评价方法中,SGA的预测价值最高,可作为临床首选。Objective To analyze the relationship between different nutritional evaluation methods and liver function classification in the patients with cirrhosis and ascites,so as to screen the most effective nutritional evaluation methods.Methods The clinical data of 93 patients with cirrhosis and ascites admitted in the Fuyang Second People′s Hospital from January 2018 to June 2019 were recruited for study.Based on the Child-Pugh liver function classification criteria,the patients were divided into the grade A group(n=24),the grade B group(n=26)and the grade C group(n=43).The nutritional status of the 3 groups was evaluated by subjective global assessment(SGA),mini nutritional assessment(MNA),nutritional risk screening 2002(NRS 2002),and various related indicators,such as body mass index(BMI),triceps skinfold thickness(TSF),upper arm muscle circumference(AMC),serum albumin(ALB),prealbumin(PA),total lymphocyte count(TLC).The ROC curve was drawn to test the application value of different nutritional evaluation methods in liver function classification of patients with cirrhosis with ascites.Results No statistical differences could be noted in BMI,when comparisons were made between the 3 groups(P>0.05).Statistical differences could be found in MNA,NRS 2002,TSF,AMC and TLC,when SGA,ALB and PA were compared with those of the grade B group and the grade A group(P<0.05).Statistical differences could also be noticed in SGA,MNA,TSF and ALB of the grade B group,when compared with those of the grade A group(P<0.05).ROC curve showed that the areas under the curve of SGA,MNA,NRS2002,TSF,AMC,ALB,PA and TLC used in the prediction of liver function classification of cirrhosis with ascites were respectively 0.888,0.787,0.722,0.685,0.414,0.768,0.671 and 0.675,of which SGA had the highest predictive value.Conclusion SGA displayed the best predictive value in the effective nutritional evaluation methods for liver function classification in the patients with cirrhosis and ascites.For this reason,it could be used as the first choice in clini

关 键 词：肝硬化腹水 主观全面评定 肝功能分级 

分 类 号：R575[医药卫生—消化系统]