肝硬化营养支持的研究进展

何玉梅; 伍丽萍; 王治铭; 郝梦昊; 胡玲; 李佳珍; 孙晓滨

doi:10.3969/j.issn.1001-5256.2022.12.031

肝硬化营养支持的研究进展

DOI: 10.3969/j.issn.1001-5256.2022.12.031

何玉梅¹,
伍丽萍^2a, , ,,
王治铭³,
郝梦昊³,
胡玲^2a,
李佳珍^2b,
孙晓滨^2a

1.
川北医学院，四川南充 623300
2a.
成都市第三人民医院消化内科，成都 610031
2b.
成都市第三人民医院营养科，成都 610031
3.
西南交通大学医学院，西南交通大学附属医院，成都 610031

基金项目:

国家自然科学基金青年科学基金项目 (81700467);

成都市第五批技术创新研发项目 (2021-YF05-00585-SN);

四川省重点研发项目 (2022YFS0340);

成都市卫健委项目 (202103031154)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：何玉梅、王治铭、郝梦昊负责查阅文献和撰写论文；胡玲、李佳珍、孙晓滨负责修改论文；伍丽萍拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
伍丽萍，wuliping1985116@163.com

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出版历程
- 收稿日期: 2022-04-22
- 录用日期: 2022-08-02
- 出版日期: 2022-12-20

Research progress in nutritional support for liver cirrhosis patients

1.
North Sichuan Medical College, Nanchong, Sichuan 623300, China
2a.
Department of Gastroenterology, The Third People Hospital of Chengdu, Chengdu 610031, China
2b.
Department of Clinical Nutrition, The Third People Hospital of Chengdu, Chengdu 610031, China
3.
School of Medicine, Southwest Jiaotong University, The Affiliated Hospital of Southwest Jiaotong University, Chengdu 610031, China

Research funding:

National Natural Science Foundation of China (81700467);

The Fifth Batch of Technological Innovation R & D Project of Chengdu (2021-YF05-00585-SN);

Sichuan Provincial Key R & D Project (2022YFS0340);

Chengdu Health Commission Research Project (202103031154)

More Information

Corresponding author: WU Liping, wuliping1985116@163.com (ORCID: 0000-0002-1615-3832)

摘要

摘要: 肝硬化营养不良与腹水、肝性脑病、感染等并发症及病死率有关，但目前肝硬化患者营养不良的危害与疾病负担被严重低估。本文将结合国内外最新研究，对肝硬化营养支持进行深入探讨，以期探索有效筛查、评估、干预途径，进一步指导临床实践。
- 肝硬化 /
- 营养不良 /
- 营养支持
Abstract: Malnutrition in liver cirrhosis is associated with ascites, hepatic encephalopathy, infection, and other complications even death. To date, the hazard and disease burden of malnutrition in cirrhosis patients have been severely underestimated. This review summarized the most recent advancement in the field and discussed the techniques and methodologies in detection and evaluation of malnutrition in cirrhosis patients, nutritional support therapy, and future research directions and clinical care of the patients.
- Liver Cirrhosis /
- Malnutrition /
- Nutritional Support

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参考文献(40)

[1]	JAVAID N, KHAN Z, ALI MA, et al. Evaluating the impact of early nutritional assessment and intervention in hospitalized liver cirrhosis patients[J]. Arq Gastroenterol, 2022, 59(1): 22-28. DOI: 10.1590/S0004-2803.202200001-05.
[2]	KOULENTAKI M, DRYGIANNAKIS I, MANTAKA A, et al. Nutritional assessment of greek liver cirrhosis patients: mini nutritional assessment predicts mortality[J]. Healthcare (Basel), 2022, 10(5): 859. DOI: 10.3390/healthcare10050859.
[3]	BELLANTI F, LO BUGLIO A, QUIETE S, et al. Comparison of three nutritional screening tools with the new glim criteria for malnutrition and association with sarcopenia in hospitalized older patients[J]. J Clin Med, 2020, 9(6): 1898. DOI: 10.3390/jcm9061898.
[4]	MAHARSHI S, SHARMA BC, SRIVASTAVA S. Malnutrition in cirrhosis increases morbidity and mortality[J]. J Gastroenterol Hepatol, 2015, 30(10): 1507-1513. DOI: 10.1111/jgh.12999.
[5]	Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010. 中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.
[6]	PALMER LB, KUFTINEC G, PEARLMAN M, et al. Nutrition in cirrhosis[J]. Curr Gastroenterol Rep, 2019, 21(8): 38. DOI: 10.1007/s11894-019-0706-5.
[7]	KONDRUP J. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3): 321-336. DOI: 10.1016/s0261-5614(02)00214-5.
[8]	MCFARLANE M, HAMMOND C, ROPER T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis[J]. Clin Nutr ESPEN, 2018, 23: 156-161. DOI: 10.1016/j.clnesp.2017.10.009.
[9]	DHALIWAL A, TOWEY J, LORD JM, et al. Nutrition in liver cirrhosis: a case-based overview[J]. Frontline Gastroenterol, 2020, 11(2): 155-161. DOI: 10.1136/flgastro-2018-101121.
[10]	BORHOFEN SM, GERNER C, LEHMANN J, et al. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis[J]. Dig Dis Sci, 2016, 61(6): 1735-1743. DOI: 10.1007/s10620-015-4015-z.
[11]	AMODIO P, BEMEUR C, BUTTERWORTH R, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J]. Hepatology, 2013, 58(1): 325-336. DOI: 10.1002/hep.26370.
[12]	WU Y, ZHU Y, FENG Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002[J]. Br J Nutr, 2020, 124(12): 1293-1302. DOI: 10.1017/S0007114520002366.
[13]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024.
[14]	DAǦ Z, KÖSEOǦLU H, KEKILLI M. The use of prealbumin as a predictor of malnutrition in cirrhotic patients and the effect of nutritional support in patients with low prealbumin levels[J]. Turk J Med Sci, 2020, 50(2): 398-404. DOI: 10.3906/sag-1910-27.
[15]	BAKSHI N, SINGH K. Nutrition assessment in patients undergoing liver transplant[J]. Indian J Crit Care Med, 2014, 18(10): 672-681. DOI: 10.4103/0972-5229.142177.
[16]	CICHOŻ-LACH H, MICHALAK A. A Comprehensive review of bioelectrical impedance analysis and other methods in the assessment of nutritional status in patients with liver cirrhosis[J]. Gastroenterol Res Pract, 2017, 2017: 6765856. DOI: 10.1155/2017/6765856.
[17]	BELARMINO G, GONZALEZ MC, TORRINHAS RS, et al. Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis[J]. World J Hepatol, 2017, 9(7): 401-408. DOI: 10.4254/wjh.v9.i7.401.
[18]	HOPKINSON J. Psychosocial support in cancer cachexia syndrome: the evidence for supported self-management of eating problems during radiotherapy or chemotherapy treatment[J]. Asia Pac J Oncol Nurs, 2018, 5(4): 358-368. DOI: 10.4103/apjon.apjon_12_18.
[19]	LAI JC, TANDON P, BERNAL W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(3): 1611-1644. DOI: 10.1002/hep.32049.
[20]	PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2): 485-521. DOI: 10.1016/j.clnu.2018.12.022.
[21]	WANG R, ZHANG YG, LI QQ, et al. Evaluation value of area index of the third lumbar psoas major muscle in nutritional status and prognosis of patients with cirrhosis[J]. Clin J Med Offic, 2022, 50(7): 729-732. DOI: 10.16680/j.1671-3826.2022.07.18. 王然, 张永国, 李谦谦, 等. 第三腰椎腰大肌面积指数对肝硬化患者营养状态及预后评估价值[J]. 临床军医杂志, 2022, 50(7): 729-732. DOI: 10.16680/j.1671-3826.2022.07.18.
[22]	EBADI M, TANDON P, MOCTEZUMA-VELAZQUEZ C, et al. Low subcutaneous adiposity associates with higher mortality in female patients with cirrhosis[J]. J Hepatol, 2018, 69(3): 608-616. DOI: 10.1016/j.jhep.2018.04.015.
[23]	GEORGIOU A, PAPATHEODORIDIS GV, ALEXOPOULOU A, et al. Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study[J]. Br J Nutr, 2019, 122(12): 1368-1376. DOI: 10.1017/S0007114519002277.
[24]	FIGUEIREDO FA, PEREZ RM, FREITAS MM, et al. Comparison of three methods of nutritional assessment in liver cirrhosis: subjective global assessment, traditional nutritional parameters, and body composition analysis[J]. J Gastroenterol, 2006, 41(5): 476-482. DOI: 10.1007/s00535-006-1794-1.
[25]	MORGAN MY, MADDEN AM, SOULSBY CT, et al. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis[J]. Hepatology, 2006, 44(4): 823-835. DOI: 10.1002/hep.21358.
[26]	PERUMPAIL BJ, LI AA, CHOLANKERIL G, et al. Optimizing the nutritional support of adult patients in the setting of cirrhosis[J]. Nutrients, 2017, 9(10): 1114. DOI: 10.3390/nu9101114.
[27]	BISCHOFF SC, BERNAL W, DASARATHY S, et al. ESPEN practical guideline: Clinical nutrition in liver disease[J]. Clin Nutr, 2020, 39(12): 3533-3562. DOI: 10.1016/j.clnu.2020.09.001.
[28]	FIALLA AD, ISRAELSEN M, HAMBERG O, et al. Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis[J]. Liver Int, 2015, 35(9): 2072-2078. DOI: 10.1111/liv.12798.
[29]	HOU W, WANG ZY, DONG JL, et al. Application of enteral nutrition and late evening snacks in patients with liver cirrhosis[J]. Clin Med J, 2019, 17 (4): 33-37. DOI: 10.3969/j.issn.1672-3384.2019.04.008. 侯维, 王忠英, 董金玲, 等. 肠内营养及睡前加餐在肝硬化患者中的应用效果评价[J]. 临床药物治疗杂志, 2019, 17(4): 33-37. DOI: 10.3969/j.issn.1672-3384.2019.04.008.
[30]	SHERGILL R, SYED W, RIZVI SA, et al. Nutritional support in chronic liver disease and cirrhotics[J]. World J Hepatol, 2018, 10(10): 685-694. DOI: 10.4254/wjh.v10.i10.685.
[31]	SINGER P, BLASER AR, BERGER MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1): 48-79. DOI: 10.1016/j.clnu.2018.08.037.
[32]	BAGER P, OLESEN L, BALTZER RL, et al. Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: a randomised controlled study[J]. Br J Nurs, 2020, 29(20): 1148-1154. DOI: 10.12968/bjon.2020.29.20.1148.
[33]	PLAUTH M, CABRÉ E, RIGGIO O, et al. ESPEN guidelines on enteral nutrition: liver disease[J]. Clin Nutr, 2006, 25(2): 285-294. DOI: 10.1016/j.clnu.2006.01.018.
[34]	PLAUTH M, CABRÉ E, CAMPILLO B, et al. ESPEN guidelines on parenteral nutrition: hepatology[J]. Clin Nutr, 2009, 28(4): 436-444. DOI: 10.1016/j.clnu.2009.04.019.
[35]	REINTAM BLASER A, STARKOPF J, ALHAZZANI W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines[J]. Intensive Care Med, 2017, 43(3): 380-398. DOI: 10.1007/s00134-016-4665-0.
[36]	ASLAM M, FAROOQ S, RIZWAN B, et al. Assessment of nutritional status of the cirrhotic patients on enteral and parenteral feeding[J]. Nutr Health, 2022, 28(1): 69-76. DOI: 10.1177/02601060211020968.
[37]	TAJIRI K, SHIMIZU Y. Branched-chain amino acids in liver diseases[J]. World J Gastroenterol, 2013, 19(43): 7620-7629. DOI: 10.3748/wjg.v19.i43.7620.
[38]	SAKAI Y, IWATA Y, ENOMOTO H, et al. Two randomized controlled studies comparing the nutritional benefits of branched-chain amino acid (BCAA) granules and a BCAA-enriched nutrient mixture for patients with esophageal varices after endoscopic treatment[J]. J Gastroenterol, 2015, 50(1): 109-118. DOI: 10.1007/s00535-014-0950-2.
[39]	PARK JG, TAK WY, PARK SY, et al. Effects of Branched-Chain Amino Acid (BCAA) supplementation on the progression of advanced liver disease: A Korean Nationwide, Multicenter, Prospective, Observational, Cohort Study[J]. Nutrients, 2020, 12(5): 1429. DOI: 10.3390/nu12051429.
[40]	LES I, DOVAL E, GARCÍA-MARTÍNEZ R, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study[J]. Am J Gastroenterol, 2011, 106(6): 1081-1088. DOI: 10.1038/ajg.2011.9.