肝硬化患者低强度运动临床观察

Clinical observation of physical exercise with low intensity in patients with cirrhosis

目的评估低强度运动对抗肝硬化相关慢性营养不良和骨骼肌量减少的安全性和有效性。方法选择2014年12月—2015年10月肝硬化患者37例,其中接受低强度运动(运动组)19例,对照组18例,观察患者对3个月低强度体能锻炼的耐受度,比较两组患者上臂围、"起立-行走"时间、门静脉宽度和Child-Pugh评分。结果实施运动3个月后,运动组患者上臂围和"起立-行走"时间分别为(33.99±2.15)cm和(9.17±0.35)s,与该组实施运动前[(32.09±2.58)cm、(9.77±0.46)s]和同期对照组[(31.93±2.04)cm、(9.76±0.30)s]相比,差异均有统计学意义(P<0.05)。运动组患者门静脉宽度改变量为(–1.11±1.94)mm,优于对照组[(0.12±1.17)mm],差异有统计学意义(P=0.031)。超重的肝硬化患者门脉宽度改善情况与实施运动前体质量指数呈正相关(r=0.93,P=0.007)。结论低强度运动对抗肝硬化相关的慢性营养不良和骨骼肌量降低具有安全性和有效性,体质量指数超标或营养不良早期患者可能获得更大受益。

Objective To evaluate the efficiency and security of physical exercise with low intensity against malnutrition and sarcopenia in patients with cirrhosis. Methods Between December 2014 and October 2015, 37 patients with cirrhosis were divided into two groups according to their willings, with 19 in the exercise group and 18 in the control group. Endurance of the exercise for 3 months were recorded. Mid-arm circumference, ＂up and go＂ time, width of portal vein and Child-Pugh score were compared before and after the research between the two groups. Results Three months later, the mid-arm circumference and the ＂up and go＂ time of the exercise group [（33.99±2.15） cm, （9.17±0.35） s] were better than those before the exercise [（32.09±2.58） cm, （9.77±0.46） s] and those in the control group [（31.93±2.04） cm, （9.76±0.30） s], and the differences above were all statistically significant （P〈0.05）. The change of the width of portal vein was positively correlated with pre-exercise body mass index in overweight patients （r=0.93, P=0.007）. Conclusions Physical exercise with low intensity is safe and effective against malnutrition and sarcopenia in patients with cirrhosis. Overweitht patiens or malnutrition at the early stage may benefit more.