CAJ | 학술논문

目的目前对我国住院肝病患者营养状况的了解不多.本研究拟调查住院肝病患者的营养风险及营养不良发生率,分析其营养风险和预后的关系,为进一步临床干预提供参考信息. 方法选取我院人工肝中心2012年4月至2012年12月住院的肝病患者331例,用实际体质量占理想体质量百分比、三头肌皮褶厚度(TSF)及上臂肌围(MAMC)评价其营养状况.用营养风险筛查2002表评估患者营养风险.同时记录患者的体质量指数、握力、白蛋白、前白蛋白、淋巴细胞计数、住院天数、住院期间并发症隋况、有无酗酒史和出院转归.对存在肝硬化的患者记录其入院时和出院时的肝功能Child-Pugh分级.均值比较用t检验,率的比较用x2检验或Firsher’s精确检验.结果入院时有营养风险的患者共有113例,占34.1％,其中慢性肝炎组有营养风险的比例最低,为17.02％；慢加急性肝衰竭组有营养风险的比例最高,达56.52％.用TSF和MAMC评价患者营养状况,其总体营养不良发生率分别为36.9％和38.7％.有营养风险的肝硬化/肝癌患者中Child-Pugh分级C级的比例显著高于无营养风险的患者.有酗酒史的患者,用TSF评价其营养状况,存在营养不良的比例高于无酗酒史的患者.有营养风险者的体质量指数及握力、入院时的白蛋白、前白蛋白及淋巴细胞计数均低于无营养风险者,平均住院天数、并发症的发生率、死亡比例均明显高于无营养风险者. 结论目前北京地区住院肝病患者有较高比例的营养风险及营养不良状态.TSF、MAMC均可用于评估住院肝病患者的营养状态.经营养风险筛查2002评估为有营养风险的肝病患者,其临床预后较差,需要积极进行营养干预.
목적 목전대아국주원간병환자영양상황적료해불다.본연구의조사주원간병환자적영양풍험급영양불량발생솔,분석기영양풍험화예후적관계,위진일보림상간예제공삼고신식. 방법 선취아원인공간중심2012년4월지2012년12월주원적간병환자331례,용실제체질량점이상체질량백분비、삼두기피습후도(TSF)급상비기위(MAMC)평개기영양상황.용영양풍험사사2002표평고환자영양풍험.동시기록환자적체질량지수、악력、백단백、전백단백、림파세포계수、주원천수、주원기간병발증수황、유무후주사화출원전귀.대존재간경화적환자기록기입원시화출원시적간공능Child-Pugh분급.균치비교용t검험,솔적비교용x2검험혹Firsher’s정학검험.결과 입원시유영양풍험적환자공유113례,점34.1％,기중만성간염조유영양풍험적비례최저,위17.02％；만가급성간쇠갈조유영양풍험적비례최고,체56.52％.용TSF화MAMC평개환자영양상황,기총체영양불량발생솔분별위36.9％화38.7％.유영양풍험적간경화/간암환자중Child-Pugh분급C급적비례현저고우무영양풍험적환자.유후주사적환자,용TSF평개기영양상황,존재영양불량적비례고우무후주사적환자.유영양풍험자적체질량지수급악력、입원시적백단백、전백단백급림파세포계수균저우무영양풍험자,평균주원천수、병발증적발생솔、사망비례균명현고우무영양풍험자. 결론 목전북경지구주원간병환자유교고비례적영양풍험급영양불량상태.TSF、MAMC균가용우평고주원간병환자적영양상태.경영양풍험사사2002평고위유영양풍험적간병환자,기림상예후교차,수요적겁진행영양간예.
Objective To investigate the prevalence of nutritional risk and malnutrition among inpatients with liver diseases in Beijing,China,and to evaluate the relationship between nutritional risk and prognosis.Methods A total of 331 in-patients with liver diseases under care at the Artificial Liver Center of Beijing Youan Hospital were consecutively enrolled for study between April 2012 and December 2012.Nutritional status was determined by calculating each patient's ratio of real weight to clinically ideal weight,the triceps skin fold (TSF),and the mid-upper arm muscle circumference (MAMC).Nutritional risk was estimated using the Nutritional Risk Screening questionnaire 2002 (NRS-2002).In addition,each patient's Child-Pugh stage,body mass index (BMI),power of gripping,serum albumin and pre-albumin levels,lymphocyte count,hospital length of stay,complications,alcoholism history,and outcome after discharge were recorded for analysis.Results One-hundred-and-thirteen of the patients (34.1％) were defined as at nutritional risk upon hospital admission.The ratio of nutritional risk was lowest in patients with chronic hepatitis (17.0％) and highest in patients with acute on chronic liver failure (56.5％).The ratios of malnutritionevaluated by TSF and MAMC were 36.9％ and 38.7％,respectively.Among the patients with liver cirrhosis or hepatocellular carcinoma,the ratio of Child-Pugh stage C was higher for individuals defined as at nutritional risk than for those without.When TSF-based ratio of malnutrition was higher for individuals with a history of alcoholism than for those without.BMI,power of gripping,serum albumin level,serum pre-albumin level,and lymphocyte count were all lower for individuals defined as at nutritional risk than for those without.Hospital stay,ratio of complication onset,and ratio of death were all higher for individuals defined as at nutritional risk than for those without.Conclusion TSF and MAMC can be used to evaluate the nutritional status of in-patients with liver diseases.Patients with nutritional risk (as determined by the NRS-2002) have poorer prognosis and may benefit from nutritional intervention.