预后营养指数在乙型肝炎肝硬化患者病情严重程度及预后评估中的应用

Application of prognostic nutritional index in the disease severity and prognosis of patients with hepatitis B cirrhosis

目的探讨预后营养指数(PNI)与乙型肝炎肝硬化病情严重程度及预后的关系。方法回顾性分析2017年1—12月扬州大学附属医院就诊的84例乙型肝炎肝硬化患者的临床资料,比较PNI与营养风险筛查2002(NRS2002)在评价乙型肝炎肝硬化患者营养状况方面的相关性与一致性,根据PNI将患者分为高PNI组(PNI≥45)与低PNI组(PNI<45),比较两组患者临床特征的差异,同时分析PNI与乙型肝炎肝硬化病情严重程度的相关性。结果PNI法评定的患者营养不良发生率较低(32例,38.10%),NRS2002法评定的患者营养不良发生率较高(69例,82.14%),差异有统计学意义(P<0.05)。两组不同PNI患者的实验室检查指标比较,高PNI组与低PNI组在外周血红细胞计数(RBC)、血红蛋白(HB)、外周血总淋巴细胞计数(LY)、白蛋白(ALB)及前白蛋白值(PA)比较,差异均有统计学意义(均P<0.05)。两组患者在外周血白细胞计数(WBC)、血肌酐(SCr)、尿素氮(BUN)、谷丙转氨酶(ALT)及谷草转氨酶(AST)比较,差异均无统计学意义(均P>0.05)。两组不同PNI患者的人体测量指标比较,高PNI组与低PNI组BMI及上臂肌围(MAMC)比较,差异有统计学意义(P<0.05)。两组患者肱三头肌皮褶厚度(TSF)及优势手握力比较,差异无统计学意义(P>0.05)。PNI与患者的Child-Turcotte-Pugh分级(r=-0.300,P=0.006)、终末期肝病模型(MELD)评分(r=-0.534,P=0.000)和血清钠与终末期肝病模型联合公式模型(MELD-Na)评分(r=-0.905,P=0.000)呈负相关,且相关程度依次增强。结论PNI可作为乙型肝炎肝硬化患者临床筛查营养风险,辅助评估病情严重程度及预后的一项有效指标。

Objective To explore the relationship between prognostic nutritional index and hepatitis B cirrhosis and its clinical application value.Methods The clinical data of 84 patients with hepatitis B cirrhosis treated in Affiliated Hospital of Yangzhou University from January to December 2017 were retrospectively analyzed.The correlation and consistency between prognostic nutrition index(PNI)and nutritional risk screening 2002(NRS2002)in evaluating the nutritional status of patients with hepatitis B cirrhosis were compared.According to PNI,patients were divided into high PNI group(PNI≥45)and low PNI group(PNI<45).Clinical character between the two group were compared,and at the same time,the correlation between PNI and disease severity of hepatitis B cirrhosis was analyzed.Results The undernourishment rate of patients evaluated by PIN method was significantly lower than by NRS2002 method(38.10%vs.82.14%,P<0.05).There were significant differences in red blood cell count,hemoglobin,total lymphocyte count,albumin,prealbumin between the high PIN group(52 cases)and the low PIN group(32 cases)(P<0.05),and there was no significant difference in white blood cell(count),creatinine,urea nitrogen,alanine aminotransferase,aspartate aminotransferuse between the two groups(P>0.05).These anthropometric indicators such as body mass index(BMI)and mid-arm muscle circumference(MAMC)were significantly different(P<0.05),but there was no statistically difference in thickness of humeral triceps,dominant grip(P>0.05).PNI was negatively correlated with Child-Turcotte-Pugh grade(r=-0.300,P=0.006),model for end-stage liver disease score(r=-0.534,P=0.000)and serum sodium combined end-stage liver disease model score(r=-0.905,P=0.000)of patients,and the degree of correlation increased in turn.Conclusion PNI can be used as an effective index for clinical screening of nutritional risk and assistant assessment of disease severity and prognosis of patients with hepatitis B cirrhosis.