握力测量法在肝硬化病人营养状态评估中的临床应用  

Clinical application value of grip strength measurement in the assessment of nutritional status of patients with cirrhosis

作　　者：康颖 祁平平 曹琳琳 杨欣 KANG Ying;QI Ping-ping;CAO Lin-lin;YANG Xin(Department of Gastroenterology,Xuzhou First People′s Hospital,The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221002,China)

机构地区：[1]江苏省徐州市第一人民医院,徐州医科大学附属徐州市立医院消化科,221002

出　　处：《蚌埠医学院学报》2020年第10期1370-1374,共5页Journal of Bengbu Medical College

摘　　要：目的:探讨握力(GS)测量法在肝硬化病人营养状态评估中的应用价值。方法:选择住院治疗的肝硬化病人76例,采用微型营养表(MNA-SF)评估肝硬化病人的营养状况,并根据MNA-SF评分将病人分为营养正常组(n=21)、营养不良风险组(n=30)、营养不良组(n=25),分别测量3组病人的人体测量指标、人体成分指标、生化指标以及静息能量消耗,并与GS进行相关性分析。结果:营养正常组病人的GS、上臂围(MAC)、上臂肌围(AMC)、小腿围(CC)、肱三头肌皮褶厚度(TSF)、体质量指数(BMI)均显著高于营养不良风险组、营养不良组(P<0.01);营养不良风险组病人的GS、MAC、AMC、CC、TSF、BMI均显著高于营养不良组(P<0.01)。3组病人的细胞内液(ICW)、细胞外液(ECW)、身体总水(TBW)比较差异无统计学意义(P>0.05);营养正常病人病人的浮肿指数(ECW/TBW)显著低于营养不良风险组、营养不良组(P<0.01);营养不良风险组病人的ECW/TBW显著低于营养不良组(P<0.01)。营养不良风险组、营养不良组病人的静息能量消耗实测值(REE Prre)明显高于静息能量消耗预测值(REE Meal)(P<0.01);营养不良风险组、营养不良组病人的REE Prre明显高于营养正常组(P<0.01);营养不良组病人的REE Prre明显高于营养不良风险组(P<0.01)。营养正常组病人的视黄醇结合蛋白(RBP)、血清白蛋白(ALB)、血红蛋白(Hb)、纤维连接蛋白(FN)、转铁蛋白(TRF)、前白蛋白(PA)、总淋巴细胞计数(TLC)水平明显高于营养不良风险组、营养不良组(P<0.01);营养不良风险组病人的TRF、ALB、Hb、FN、RBP、PA、TLC水平明显见高于营养不良组(P<0.01)。Pearson相关性分析显示,握力与MAC、AMC、CC、BMI、ALB呈显著正相关(P<0.01);握力与TSF、REE Prre呈显著负相关关系(P<0.01);握力与TRF、PA、Hb、FN、RBP、TLC无相关性(P>0.05)。结论:握力与肝硬化病人的其他营养性指标具有密切相关性,故握力测量法可作为肝硬化�Objective:To explore the application value of grip strength(GS)measurement in the assessment of nutritional status of patients with cirrhosis.Methods:The nutritional status of 76 patients with cirrhosis were assessed using MNA-SF.According to the MNA-SF score,the patients were divided into the normal nutrition group(n=21),malnutrition risk group(n=30)and malnutrition group(n=25).The anthropometric index,human component index,biochemical index and resting energy consumption in three groups were measured,and their correlation with GS were analyzed.Results:The GS,MAC,AMC,CC,TSF and BMI in normal nutrition group were significantly higher than those in malnutrition risk group and malnutrition group(P<0.01);and the GS,MAC,AMC,CC,TSF and BMI in malnutrition risk group were significantly higher than those in malnutrition group(P<0.01).There was no statistical significance in the ICW,ECW and TBW among three groups(P>0.05).The ECW/TBW in normal nutrition group was significantly lower than that in malnutrition risk group and malnutrition group(P<0.05),and the ECW/TBW in malnutrition risk group was significantly lower than that in malnutrition group(P<0.01).In malnutrition risk group and malnutrition group,the REE Prre were significantly higher than REE Meal(P<0.01),the REE Prre in malnutrition risk group and malnutrition group were significantly higher than that in normal group(P<0.01),and the REE Prre in malnutrition group was significantly higher than that in malnutrition risk group(P<0.01).The results of Pearson correlation analysis showed that GS was positively correlated with MAC,AMC,CC,BMI and ALB(P<0.01),negatively correlated with TSF and REE Prre(P<0.01),and not correlated with TRF,PA,Hb,FN,RBP and TLC(P>0.05).Conclusions:GS is closely related to other nutritional indicators in patients with cirrhosis.Therefore,GS measurement can be used as a nutritional status assessment method in patients with cirrhosis,and it can be further popularized in clinical practice.

关 键 词：肝硬变 握力测量法 营养状态 

分 类 号：R575.2[医药卫生—消化系统]