不同营养筛查工具评估肝病患者营养状况的价值

Value of different nutritional screening tools on evaluating nutritional status of patients with liver disease

目的探讨不同营养筛查工具在肝病患者营养状况评估中的应用价值.方法选取2018年8月1日至2019年3月1日西安交通大学医学院第二附属医院收治的214例肝病患者为研究对象,通过身体质量指数(body mass index,BMI)、营养不良风险筛查量表(NRS2002)、生物化学指标(血清白蛋白、血红蛋白、前白蛋白)分别评估肝病患者的营养状况,比较不同评估方法间的差异.结果不同营养筛查指标显示肝病患者营养不良的发生率分别为BMI 23.36%,NRS200238.79%,白蛋白45.79%,血红蛋白43.46%,前白蛋白85.05%.Spearman相关性分析显示,白蛋白与前白蛋白的相关性最高(r=0.3591,P<0.0001),BMI与NRS2002评分的相关性较高(r=0.3537,P=0.0001),NRS2002评分与白蛋白、血红蛋白及前白蛋白的相关系数分别为0.2693、0.1921、0.2262(P值分别为0.0321、0.0411、0.0031).上述指标在肝硬化患者中筛查营养不良发生率均较非肝硬化患者高,其中两组BMI、白蛋白与前白蛋白差异有统计学意义(χ2值分别为7.909、4.098、6.313,P值分别为0.005、0.043、0.012).除了BMI在不同性别肝病患者营养状况筛查中有统计学差异(χ2=8.677,P=0.003),其余各筛查指标对不同年龄、性别肝病患者的营养状况筛查均未见明显差异(P>0.05).结论 BMI、NRS2002和生物化学指标(血清白蛋白、血红蛋白、前白蛋白)有明显相关性,均可用于临床肝病患者的营养评估;但NRS2002简便易行,重复性好,适用范围较广,较其他指标临床操作性强.

Objective To analyze the value of different nutritional screening tools on the evaluation of nutritional status of patients with liver diseases. Methods Total of 214 patients with liver diseases in the Second Affiliated Hospital of Medical College, Xian Jiaotong University From August 1st, 2018 to March 1st, 2019 were enrolled. Body mass index (BMI), malnutrition risk screening (NRS2002) and biochemical indicators (serum albumin, hemoglobin and pre-albumin) were used to assess the nutritional status of patients with liver disease, and the differences among different assessment methods were furtherly compared. Results Different nutritional screening indicators showed that the incidence of malnutrition in patients with liver diseases were 23.36% for BMI, 38.79% for NRS2002, 45.79% for albumin, 43.46% for hemoglobin and 85.05% for prealbumin, respectively. Correlation analysis showed that albumin had the highest correlation with prealbumin (r = 0.3591, P < 0.0001), the correlation between BMI and NRS2002 score was higher (r = 0.3537, P = 0.0001), and the correlation coefficients of NRS2002 score with albumin, hemoglobin and prealbumin were 0.2693, 0.1921 and 0.2262, respectively (P = 0.0321, 0.0411, 0.0031). Hierarchical analysis showed that the positive rate of the above indicators in patients with cirrhosis was higher than that in noncirrhotic patients. BMI, albumin and prealbumin had significant statistical differences between the two groups (χ2 = 7.909, 4.098, 6.313;P = 0.005, 0.043, 0.012). Except for BMI, which was statistically different in the screening of nutritional status of patients with liver disease of different genders (χ2 = 8.677, P = 0.003),the other screening indicators showed no significant difference in the screening of nutritional status among patients with liver diseases of different ages and genders (P > 0.05). Conclusions BMI, NRS2002 score and biochemical indicators (serum albumin, hemoglobin and pre-albumin) have obvious correlation and can be used for nutritional evaluation of patients with liver diseases. However, NRS2002 is simple and easy to perform, and has good repeatability and a wide application range. It is clinically more operative than the other methods.