外科肝癌患者营养状况与肝功能分级和临床结局的相关性分析

Correlation of the nutritional status with liver function and clinical outcomes in surgically treated liver cancer patients

目的评估外科肝癌患者营养状况及其与肝功能分级和临床结局的相关性。方法2011年10月至2013年10月新入院接受手术治疗的肝硬化肝癌患者112例，采用肌酐-身高指数（CHI）、上臂围、握力和蛋白代谢指标等方法，以及患者主观整体评估（PG—SGA）分别进行营养状况评估；采用Child—Pugh分级评价肝脏功能，统计术后感染并发症和术后住院日作为临床结局指标。分析营养状况与肝脏功能、临床结局的相关性。结果根据PG—SGA分级，112例患者中70例（62．5％）营养正常，34例（30．4％）有中度营养不良，8例（7．1％）重度营养不良。以PG-SGA结果为标准，CHI法（K=0．760，P=0．000）、上臂围法（K=0．564，P=0．000）及握力（K=0．523，P=0．000）均与PG．SGA一致，其中CHI法与PD—SGA法吻合程度最强。肝功能Child—Pugh分级与PG—SGA分级之间呈显著正相关（rs=0．829，P=0．000），PG—SGA分级与感染并发症及术后住院日均呈显著正相关（r=0．349，P=0．000；r=0．624，P=0．000）。结论PD—SGA结合CHI可较为准确地评估外科肝癌患者营养状况。患者的营养状况与肝脏功能分级、感染并发症发生率和术后住院日呈正相关。

Objective To investigate the relationship of the nutritional status with liver function and clinical outcomes of liver cancer patients treated with surgery. Methods Altogether 112 hospitalized patients undergoing surgical treatments for liver cancer were enrolled from October 2011 to October 2013. Their general clinical data were collected, including creatinine-height index （CHI） , arm circumference, grip strenghth, albumin, prealbumin, and transferrin. The nutritional status was assessed using Pafient-Generated Subjective Global Assessment （PG-SGA）. The liver function was assessed with Child-Pugh classification. Postoperative infectious complications and the hospital stays were recorded to assess the clinical outcomes. The correlation between nutritional status and liver function, and that between nutritional status and clinical outcomes were analyzed. Results Among the 112 patients, 70 （62. 5% ） were in normal nutritional status, 34 （30. 4% ） were with moderate malnutrition, and 8 （7. 1% ） were with severe malnutrition according to PG-SGA scores. PG-SGA assessment showed strong consistence with CHI nutritional assessment （ K = 0. 760, P = 0. 000） , and moderate consistence with arm circumference assessment （ K = 0. 564, P = 0. 000） , and grip strength assessment （ K = 0. 523, P = 0. 000）. The live function classified by Child-Pugh was found highly correlated with PG-SGA assessment （ r = 0. 829, P = 0. 000）. Postoperative infectious complications and hospital stays were both positively correlated with PG-SGA assessment （ r = 0. 349, P = 0. 000 ; r = 0. 624, P = 0. 000）.Conclusions PD-SGA combining with CHI can be used for the nutritional status assessment of liver cancer patients undergoing surgical treatments. The nutritional status of the patients has positive correlation with live function, infectious complications, and postoperative hospital stays.