基于RFH-NPT营养风险评估的饮食管理对慢性乙型肝炎肝硬化患者的影响

Effect of dietary management based on RFH-NPT nutritional risk assessment in patients with chronic hepatitis B cirrhosis

目的探讨基于皇家自由医院-营养优先次序工具(RFH-NPT)营养风险评估的饮食管理对慢性乙型肝炎肝硬化患者营养状态及肝功能的影响。方法纳入2020年3月-2023年3月医院收治的120例慢性乙型肝炎肝硬化患者为研究对象,按照组间基本资料具有可比性的原则分为对照组和观察组,各60例。对照组实施常规营养护理干预,观察组在对照组基础上实施基于RFH-NPT营养风险评估的饮食管理,两组均干预3个月。比较两组患者干预前后营养状态[体质指数(BMI)、上臂肌围(AMC)、白蛋白(ALB)、前白蛋白(PA)]、肝功能[丙氨酸转氨酶(ALT)、总胆红素(TBIL)、单胺氧化酶(MAO)]、肝纤维化程度[III型前胶原(PC-III)、IV型胶原(IV-C)、层粘连蛋白(LN)、透明质酸酶(HA)]、希望水平[Herth希望量表(HHI)]、生活质量[慢性肝病问卷(CLDQ)]。记录并比较两组患者干预期间并发症发生情况。结果干预后,观察组患者BMI、AMC、ALB、PA水平和HHI量表评分、CLDQ量表评分均高于对照组(P<0.05);干预后观察组患者ALT、TBIL、MAO水平低于对照组(P<0.05);干预后,两组患者PC-III、IV-C、LN、HA水平比较差异无统计学意义(P>0.05)。干预期间,两组患者肝肾综合征、消化道出血、腹膜炎总发生率比较差异无统计学意义(P>0.05)。结论基于RFH-NPT营养风险评估的饮食管理应用于慢性乙型肝炎肝硬化患者中,可有效改善其营养状态和肝功能,缓解其肝纤维化进程,提高患者生活质量。

Objective To explore the effect of dietary management based on Royal Free Hospital Nutritional Prioritizing Tool(RFH-NPT)nutritional risk assessment on the nutritional status and liver function of patients with chronic hepatitis B cirrhosis.Methods A total of 120 patients with chronic hepatitis B cirrhosis admitted to the hospital from March 2020 to March 2023 were included in the study.They were divided into a control group and an observation group,with 60 cases in each group,based on the principle of comparability of basic data between groups.The control group implemented routine nutritional nursing intervention,while the observation group implemented dietary management based on RFH-NPT nutritional risk assessment in addition to the routine nursing.Both groups were intervened for 3 months.The nutritional status[body mass index(BMI),arm muscle circumference(AMC),albumin(ALB),and prealbumin(PA)],liver function[alanine aminotransferase(ALT),total bilirubin(TBIL),and monoamine oxidase(MAO)],degree of liver fibrosis[type III procollagen(PC-III),typeⅣcollage(IV-C),laminin(LN),and hyaluronidase(HA)],hope levels[Herth Hope Index(HHI)],and quality of life[Chronic Liver Disease Questionnaire(CLDQ)]between the two groups of patients were compared before and after the intervention.The occurrence of complications during the intervention period between the two groups was recorded and compared.Results After intervention,the BMI,AMC,ALB and PA levels,HHI score and CLDQ score in the observation group were higher than those in the control group(P<0.05).After intervention,the ALT,TBIL and MAO levels in the observation group were lower than those in the control group(P<0.05).After intervention,there was no statistically significant difference in levels of PC-Ⅲ,IV-C,LN and HA between the two groups(P>0.05).During the intervention period,there was no statistically significant difference in the total incidence of hepatorenal syndrome,gastrointestinal bleeding,and peritonitis between the two groups of patients(P>0.05).Conclusion The application of dietary management based on RFH-NPT nutritional risk assessment in patients with chronic hepatitis B cirrhosis can effectively improve their nutritional status and liver function,alleviate the progression of liverfibrosis,and enhance the patients'quality of life.