不同营养评价方法在肝移植术前患者中的应用比较

Comparison of Preoperative Nutritional Evaluation Methods in Patients with Liver Transplantation

目的比较不同的营养评估方法对肝移植患者术前营养不良状况的评价效果。方法回顾性分析2013年3月至2016年12月接受肝移植手术的147例患者临床资料,比较不同营养评价方法对肝移植患者营养不良状况的检出率,研究营养不良发生率和肝功能Child-Turcotte-Pugh(CTP)分级的关系。结果应用主观全面评价(subjective global assessment,SGA)法、微型营养评定(mini-nutrition assessment,MNA)、营养风险筛查2002(nutritional risk screen2002,NRS2002)和上臂肌围(arm muscle circumference,AMC)、肱三头肌皮皱厚度(triceps skin fold,TSF)、血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、淋巴细胞总数(total number of lymphocytes,TLC)指标对肝移植患者营养不良状态检出效果不一致;应用SGA、MNA、NRS2002和AMC、TSF、ALB、PA、TLC等指标评估营养状态时,不同疾病分组营养状况差异存在统计学意义(均P<0.05)。营养风险发生率随CTP分级增加而上升。结论肝移植患者营养不良的发生率极高;MNA对肝移植患者营养不良检出率较高,且与CTP分级相关性较好;不同指标可以从不同方面反映患者的营养状况。

Objective To evaluate the nutrition status of patients with liver disease by using different nutritional assessments.Methods Clinical data of 147 patients who underwent liver transplantation enrolling from March 2013 to December 2016 was retrospectively analyzed.The detection rate of malnutrition in patients with liver transplantation was compared by using different nutritional evaluation methods,and meanwhile the relationship between malnutrition incidence and Child-Turcotte-Pugh (CTP) classification was also studied.Results Detection rate of malnutrition state among the patient with liver transplantation was different by using Subjective Global Assessment (SGA),Mini-Nutrition Assessment (MNA),Nutritional Risk Screen 2002 (NRS2002) and Arm Muscle Circumference (AMC),Triceps Skin Fold (TSF),serum albumin (ALB) and prealbumin (PA),the total number of lymphocytes (TLC).When assessed by using SGA,MNA,NRS2002,AMC,TSF,ALB,PA and TLC,the differences of the nutritional status between different groups of diseases were statistically significant (all P <0.05).The incidence of nutritional risk increased with the increase of CTP classification.Conclusions The incidence of malnutrition among patients with liver transplantation is extremely high.MNA has a higher detection rate of malnutrition towards patients with liver transplantation,and the correlation is good.The incidence of nutritional risk increases with the increase of CTP classification.