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肝硬化营养不良——从改善门静脉高压获益

高波 诸葛宇征

引用本文:
Citation:

肝硬化营养不良——从改善门静脉高压获益

DOI: 10.3969/j.issn.1001-5256.2021.12.005
详细信息
    通信作者:

    诸葛宇征,yuzheng9111963@aliyun.com

  • 中图分类号: R575.2

Malnutrition in liver cirrhosis: Benefits from improving portal hypertension

  • 摘要: 肝硬化患者普遍存在营养不良,尤其发展到失代偿期,营养不良发生率高,其表现形式主要为蛋白质-能量营养不良,对患者预后产生负面影响。引起肝硬化营养不良的原因主要为摄入不足和消耗增加。人体成分测定是评估肝硬化营养不良类型的一项重要方法。欧洲肠外与肠内营养学会指南建议所有肝硬化患者均需采用营养风险筛查工具(NRS2002)进行营养风险筛查,评分≥3则存在营养风险。欧洲肠外与肠内营养学会指南推荐肝硬化患者每日能量摄入30~35 kcal/kg,每日蛋白质摄入量为1.2~1.5 g/kg。经颈静脉肝内门体分流术可有效降低肝硬化患者门静脉高压,有助于改善其营养状态。

     

  • [1] PARKASH O, JAFRI W, MUNIR SM, et al. Assessment of malnutrition in patients with liver cirrhosis using protein calorie malnutrition (PCM) score verses bio-electrical impedance analysis (BIA)[J]. BMC Res Notes, 2018, 11(1): 545. DOI: 10.1186/s13104-018-3640-y.
    [2] de CARVALHO L, PARISE ER, SAMUEL D. Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation[J]. J Gastroenterol Hepatol, 2010, 25(2): 391-396. DOI: 10.1111/j.1440-1746.2009.06033.x.
    [3] DASARATHY J, ALKHOURI N, DASARATHY S. Changes in body composition after transjugular intrahepatic portosystemic stent in cirrhosis: A critical review of literature[J]. Liver Int, 2011, 31(9): 1250-1258. DOI: 10.1111/j.1478-3231.2011.02498.x.
    [4] CRUZ-JENTOFT AJ, LANDI F, SCHNEIDER SM, et al. Prevalence of and interventions for sarcopenia in ageing adults: A systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)[J]. Age Ageing, 2014, 43(6): 748-759. DOI: 10.1093/ageing/afu115.
    [5] HUISMAN EJ, TRIP EJ, SIERSEMA PD, et al. Protein energy malnutrition predicts complications in liver cirrhosis[J]. Eur J Gastroenterol Hepatol, 2011, 23(11): 982-989. DOI: 10.1097/MEG.0b013e32834aa4bb.
    [6] KALAITZAKIS E, BJORNSSON E. Hepatic encephalopathy in patients with liver cirrhosis: Is there a role of malnutrition?[J]. World J Gastroenterol, 2008, 14(21): 3438-3439. DOI: 10.3748/wjg.14.3438.
    [7] VIEIRA PM, DE-SOUZA DA, OLIVEIRA LC. Nutritional assessment in hepatic cirrhosis; clinical, anthropometric, biochemical and hematological parameters[J]. Nutr Hosp, 2013, 28(5): 1615-1621. DOI: 10.3305/nh.2013.28.5.6563.
    [8] 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.
    [9] GUGLIELMI FW, PANELLA C, BUDA A, et al. Nutritional state and energy balance in cirrhotic patients with or without hypermetabolism. Multicentre prospective study by the 'Nutritional Problems in Gastroenterology' Section of the Italian Society of Gastroenterology (SIGE)[J]. Dig Liver Dis, 2005, 37(9): 681-688. DOI: 10.1016/j.dld.2005.03.010.
    [10] LEE DH, GIOVANNUCCI EL. Body composition and mortality in the general population: A review of epidemiologic studies[J]. Exp Biol Med (Maywood), 2018, 243(17-18): 1275-1285. DOI: 10.1177/1535370218818161.
    [11] NARANJO-HERNÁNDEZ D, REINA-TOSINA J, ROA LM, et al. Smart bioimpedance spectroscopy device for body composition estimation[J]. Sensors (Basel), 2019, 20(1): 70. DOI: 10.3390/s20010070.
    [12] PROBST P, FUCHS J, SCHÖN MR, et al. Prospective study to evaluate the prognostic value of different nutritional assessment scores in liver surgery: NURIMAS Liver (DRKS00006340)[J]. Hepatobiliary Surg Nutr, 2020, 9(4): 400-413. DOI: 10.21037/hbsn.2019.06.11.
    [13] van VUGT JL, LEVOLGER S, de BRUIN RW, et al. Systematic review and Meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation[J]. Am J Transplant, 2016, 16(8): 2277-2292. DOI: 10.1111/ajt.13732.
    [14] KIM G, KANG SH, KIM MY, et al. Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis[J]. PLoS One, 2017, 12(10): e0186990. DOI: 10.1371/journal.pone.0186990.
    [15] XU JY, JIANG ZM. Re-understanding of the concept of nutritional risk from the misunderstanding of 2015 ESPEN consensus statement on diagnostic criteria for malnutrition (undernutrition)[J]. Chin J Clin Nutr, 2016, 24(5): 261-265. DOI: 10.3760/cma.j.issn.1674-635X.2016.05.002.

    许静涌, 蒋朱明. 2015年ESPEN营养不良(不足)诊断共识、营养风险及误区[J]. 中华临床营养杂志, 2016, 24(5): 261-265. DOI: 10.3760/cma.j.issn.1674-635X.2016.05.002.
    [16] EGHTESAD S, POUSTCHI H, MALEKZADEH R. Malnutrition in liver cirrhosis: The influence of protein and sodium[J]. Middle East J Dig Dis, 2013, 5(2): 65-75. http://www.tums.ac.ir/1393/04/24/574.pdf-hpoustchi-2014-07-15-10-35.pdf
    [17] 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.
    [18] Beijing Medical Association, Committee of Parenteral and Enteral Nutrition; Expert Panel on Consensus on the Parenteral and Enteral Nutritional and the Dietary Intervention for Patients with Chronic Liver Diseases. Consensus on the clinical nutritional intervention for patients with chronic liver diseases[J]. J Clin Hepatol, 2017, 33(7): 1236-1245. DOI: 10.3969/j.issn.1001-5256.2017.07.006.

    北京医学会肠外肠内营养学专业委员会, 《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会. 慢性肝病患者肠外肠内营养支持与膳食干预专家共识[J]. 临床肝胆病杂志, 2017, 33(7): 1236-1245. DOI: 10.3969/j.issn.1001-5256.2017.07.006.
    [19] LIGUORI I, RUSSO G, ARAN L, et al. Sarcopenia: Assessment of disease burden and strategies to improve outcomes[J]. Clin Interv Aging, 2018, 13: 913-927. DOI: 10.2147/CIA.S149232.
    [20] JEONG JY, LIM S, SOHN JH, et al. Presence of sarcopenia and its rate of change are independently associated with long-term mortality in patients with liver cirrhosis[J]. J Korean Med Sci, 2018, 33(50): e299. DOI: 10.3346/jkms.2018.33.e299.
    [21] KANG SH, JEONG WK, BAIK SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: Going beyond the hepatic venous pressure gradient and MELD score[J]. J Cachexia Sarcopenia Muscle, 2018, 9(5): 860-870. DOI: 10.1002/jcsm.12333.
    [22] NARDELLI S, LATTANZI B, TORRISI S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J]. Clin Gastroenterol Hepatol, 2017, 15(6): 934-936. DOI: 10.1016/j.cgh.2016.10.028.
    [23] HANAI T, SHIRAKI M, NISHIMURA K, et al. Sarcopenia impairs prognosis of patients with liver cirrhosis[J]. Nutrition, 2015, 31(1): 193-199. DOI: 10.1016/j.nut.2014.07.005.
    [24] Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications[J]. Clin Mol Hepatol, 2018, 24(3): 230-277. DOI: 10.3350/cmh.2018.1005.
    [25] CAMCI C, GURAKAR A, KANOSKI M, et al. Nutritional effects of transjugular intrahepatic portosystemic shunt—an often neglected benefit? "A preliminary report"[J]. J Okla State Med Assoc, 2009, 102(1): 10-11. http://www.ncbi.nlm.nih.gov/pubmed/19271637
    [26] STURM L, BETTINGER D, GIESLER M, et al. Treatment with proton pump inhibitors increases the risk for development of hepatic encephalopathy after implantation of transjugular intrahepatic portosystemic shunt (TIPS)[J]. United European Gastroenterol J, 2018, 6(9): 1380-1390. DOI: 10.1177/2050640618795928.
    [27] DASARATHY J, ALKHOURI N, DASARATHY S. Changes in body composition after transjugular intrahepatic portosystemic stent in cirrhosis: A critical review of literature[J]. Liver Int, 2011, 31(9): 1250-1258. DOI: 10.1111/j.1478-3231.2011.02498.x.
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  • 收稿日期:  2021-08-04
  • 录用日期:  2021-08-31
  • 出版日期:  2021-12-20
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