婴儿胆汁淤积性肝病的营养评估与治疗管理

杜丽娜; 夏露露; 闫洁; 郭紫云; 杨燕

doi:10.3969/j.issn.1001-5256.2022.01.041

婴儿胆汁淤积性肝病的营养评估与治疗管理

DOI: 10.3969/j.issn.1001-5256.2022.01.041

a.
国家儿童医学中心，首都医科大学附属北京儿童医院中医科，北京 100045
b.
国家儿童医学中心，首都医科大学附属北京儿童医院临床营养科，北京 100045

基金项目:

中国民族医药学会科研项目 (2020ZY278-400403);

北京市属医院科研培育计划 (PZ2022027)

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：杜丽娜负责文献搜集及论文撰写；夏露露、闫洁负责修改文章; 郭紫云负责部分文献搜集; 杨燕负责指导及修改文章。

详细信息

通信作者:
杨燕，yy2303@sina.com

计量
- 文章访问数: 482
- HTML全文浏览量: 131
- PDF下载量: 47
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-06
- 录用日期: 2021-07-28
- 出版日期: 2022-01-20

Nutritional assessment and treatment management of infantile cholestatic liver disease

Lina DU^a,
Lulu XIA^b,
Jie YAN^b,
Ziyun GUO^a,
Yan YANG^{a
, ,}

a.
National Center for Children's Health, Department of Traditional Chinese Medicine, Capital Medical University, Beijing 100045, China
b.
National Center for Children's Health, Department of Clinical Nutrition, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China

Research funding:

Scientific Research Projects of China Medical Association of Minorities (2020ZY278-400403);

Bejing Municipal Administration of Hospital Incubating Program (PZ2022027)

摘要

摘要: 婴儿胆汁淤积性肝病患者常伴有营养不良，而营养不良又可以影响其预后发展。引起营养不良的因素很多，也有多种营养不良的评价方法，但目前肝病患者的营养评估没有统一的标准，需要多种指标和方法进行综合分析评估。分析了胆汁淤积性肝病患者营养不良的常见原因，介绍了营养评估方法，包括人体测量、实验室检查、营养评价工具等，并对营养干预治疗进行了阐述，以提高胆汁淤积性肝病患者营养问题的认识。早期识别以及合理干预有助于提高患者的生活质量，改善预后。
- 胆汁淤积, 肝内 /
- 营养评价 /
- 治疗学
Abstract: Children with infantile cholestatic liver disease are often accompanied by malnutrition, which in turn can affect its progression and prognosis. There are many factors causing malnutrition and various methods for malnutrition assessment, but there is still a lack of uniform standard for nutritional assessment in patients with liver diseases, and a variety of indicators and methods are required for comprehensive analysis and assessment. This article analyzes the common causes of malnutrition in children with cholestatic liver disease, introduces the different methods for nutritional assessment, including anthropometric measurements, laboratory examination, and nutritional assessment tools, and elaborates on nutritional intervention treatment, so as to improve the understanding of nutritional problems in children with cholestatic liver disease. Early identification and rational interventions can help to improve the quality of life and prognosis of children.
- Cholestasis, Intrahepatic /
- Nutrition Assessment /
- Therapeutics

HTML全文

参考文献(40)

[1]	MARTÍNEZ-UÑA M, LÓPEZ-MANCHEÑO Y, DIÉGUEZ C, et al. Unraveling the role of leptin in liver function and its relationship with liver diseases[J]. Int J Mol Sci, 2020, 21(24): 9368. DOI: 10.3390/ijms21249368.
[2]	SANTETTI D, DE ALBUQUERQUE WILASCO MI, DORNELLES CT, et al. Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease[J]. World J Gastroenterol, 2015, 21(29): 8927-8934. DOI: 10.3748/wjg.v21.i29.8927.
[3]	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.
[4]	KELLY DA, PROTEROE S, CLARKE S. Acute and chronic liver disease[M]// In Nutrition in Pediatrics. 5th ed. USA: People's Medical Publishing House-USA, 2016: 851-863.
[5]	GHUFRAN A. Nutrition in chronic liver disease: A point-of-care review[J]. Nutr Clin Pract, 2020, 35(2): 211-217. DOI: 10.1002/ncp.10470.
[6]	BONEFELD K, MØLLER S. Insulin-like growth factor-I and the liver[J]. Liver Int, 2011, 31(7): 911-919. DOI: 10.1111/j.1478-3231.2010.02428.x.
[7]	BECKER P, CARNEY LN, CORKINS MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition)[J]. Nutr Clin Pract, 2015, 30(1): 147-161. DOI: 10.1177/0884533614557642.
[8]	NORMATOV I, KAPLAN S, AZZAM RK. Nutrition in pediatric chronic liver disease[J]. Pediatr Ann, 2018, 47(11): e445-e451. DOI: 10.3928/19382359-20181022-03.
[9]	FABIANSEN C, PHELAN K, CICHON B, et al. Short malnourished children and fat accumulation with food supplementation[J]. Pediatrics, 2018, 142(3): e20180679. DOI: 10.1542/peds.2018-0679.
[10]	STEPHENS K, ORLICK M, BEATTIE S, et al. Examining mid-upper arm circumference malnutrition z-score thresholds[J]. Nutr Clin Pract, 2020, 35(2): 344-352. DOI: 10.1002/ncp.10324.
[11]	GAO F, ZHANG WQ, LIANG SQ, et al. Application of serum albumin, prealbumin and transferrin in the evaluation of nutritional support for patients with chronic liver failure[J]. J Pract Med, 2017, 33(4): 603-605. DOI: 10.3969/j.issn.1006-5725.2017.04.027. 高飞, 张卫青, 梁首勤, 等. 血清白蛋白、前白蛋白和转铁蛋白在评价慢性肝衰竭患者营养支持中的应用[J]. 实用医学杂志, 2017, 33(4): 603-605. DOI: 10.3969/j.issn.1006-5725.2017.04.027.
[12]	DASARATHY S. Myostatin and beyond in cirrhosis: All roads lead to sarcopenia[J]. J Cachexia Sarcopenia Muscle, 2017, 8(6): 864-869. DOI: 10.1002/jcsm.12262.
[13]	MEDHAT AS, AHMED AO, AHMED FT, et al. Creatinine height index as a predictor of nutritional status among patients with liver cirrhosis[J]. J Public Health Epidemiol, 2016, 8(10): 220-228. DOI: 10.5897/JPHE2016.0850.
[14]	RABITO EI, MARCADENTI A, DA SILVA FINK J, et al. Nutritional risk screening 2002, short nutritional assessment questionnaire, malnutrition screening tool, and malnutrition universal screening tool are good predictors of nutrition risk in an emergency service[J]. Nutr Clin Pract, 2017, 32(4): 526-532. DOI: 10.1177/0884533617692527.
[15]	MCCARTHY H, MCNULTY H, DIXON M, et al. Screening for nutrition risk in children: The validation of a new tool[J]. J Hum Nutr Diet, 2008, 21(4): 395-396. DOI: 10.1111/j.1365-277X.2008.00881_31.x.
[16]	REED M, MULLANEY K, RUHMANN C, et al. Screening tool for the assessment of malnutrition in pediatrics (STAMP) in the electronic health record: A validation study[J]. Nutr Clin Pract, 2020, 35(6): 1087-1093. DOI: 10.1002/ncp.10562.
[17]	GERASIMIDIS K, KEANE O, MACLEOD I, et al. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital[J]. Br J Nutr, 2010, 104(5): 751-756. DOI: 10.1017/S0007114510001121.
[18]	HULST JM, ZWART H, HOP WC, et al. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children[J]. Clin Nutr, 2010, 29(1): 106-111. DOI: 10.1016/j.clnu.2009.07.006.
[19]	MACIEL J, NAKANO EY, CARVALHO K, et al. STRONGkids validation: Tool accuracy[J]. J Pediatr (Rio J), 2020, 96(3): 371-378. DOI: 10.1016/j.jped.2018.12.012.
[20]	RIPKA WL, ORSSO CE, HAQQ AM, et al. Lean mass reference curves in adolescents using dual-energy x-ray absorptiometry (DXA)[J]. PLoS One, 2020, 15(2): e0228646. DOI: 10.1371/journal.pone.0228646.
[21]	SCHMIDT SC, BOSY-WESTPHAL A, NIESSNER C, et al. Representative body composition percentiles from bioelectrical impedance analyses among children and adolescents. The MoMo study[J]. Clin Nutr, 2019, 38(6): 2712-2720. DOI: 10.1016/j.clnu.2018.11.026.
[22]	KIGARU D, NDUNG'U ZW, MACHARIA-MUTIE CW. Application of stable isotope dilution techniques to assess body fat and comparison with WHO BMI-for-age classification as a measure of obesity among schoolchildren in Nairobi, Kenya[J]. Public Health Nutr, 2021, 24(12): 3587-3591. DOI: 10.1017/S1368980020001950.
[23]	BECKER PJ, GUNNELL BELLINI S, WONG VEGA M, et al. Validity and reliability of pediatric nutrition screening tools for hospital, outpatient, and community settings: A 2018 evidence analysis center systematic review[J]. J Acad Nutr Diet, 2020, 120(2): 288-318. e2. DOI: 10.1016/j.jand.2019.06.257.
[24]	GONG ST. Nutritional treatment of infantile cholestatic liver disease[J]. Chin J Pract Pediatr, 2013, 28(4): 258-260. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201304008.htm 龚四堂. 婴儿胆汁淤积性肝病营养治疗[J]. 中国实用儿科杂志, 2013, 28(4): 258-260. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201304008.htm
[25]	WU MC, MENG QH. Nutritional assessment and clinical management of patients with acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(4): 770-774. DOI: 10.3969/j.issn.1001-5256.2021.04.006. 吴牧晨, 孟庆华. 慢加急性肝衰竭患者的营养评估及临床管理[J]. 临床肝胆病杂志, 2021, 37(4): 770-774. DOI: 10.3969/j.issn.1001-5256.2021.04.006.
[26]	CHEN X, WANG J, LU Y, et al. Feeding practices in 6-24-month-old children with chronic cholestatic liver diseases: A mixed-method study[J]. BMC Pediatr, 2020, 20(1): 395. DOI: 10.1186/s12887-020-02290-8.
[27]	YANG CH, PERUMPAIL BJ, YOO ER, et al. Nutritional needs and support for children with chronic liver disease[J]. Nutrients, 2017, 9(10): 1127. DOI: 10.3390/nu9101127.
[28]	IQBAL U, JADEJA RN, KHARA HS, et al. A comprehensive review evaluating the impact of protein source (vegetarian vs. meat based) in hepatic encephalopathy[J]. Nutrients, 2021, 13(2): 370. DOI: 10.3390/nu13020370.
[29]	GLUUD LL, DAM G, LES I, et al. Branched-chain amino acids for people with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2017, 5: CD001939. DOI: 10.1002/14651858.CD001939.pub4.
[30]	HAMED A, HAMED A, LAMBERT K. Branched-chain amino acids for people with hepatic encephalopathy[J]. Am Fam Physician, 2020, 101(1): Online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481897/
[31]	SHNEIDER BL, MAGEE JC, KARPEN SJ, et al. Total serum bilirubin within 3 months of hepatoportoenterostomy predicts short-term outcomes in biliary atresia[J]. J Pediatr, 2016, 170: 211-217. e1-e2. DOI: 10.1016/j.jpeds.2015.11.058.
[32]	VENKAT VL, SHNEIDER BL, MAGEE JC, et al. Total serum bilirubin predicts fat-soluble vitamin deficiency better than serum bile acids in infants with biliary atresia[J]. J Pediatr Gastroenterol Nutr, 2014, 59(6): 702-707. DOI: 10.1097/MPG.0000000000000547.
[33]	YILMAZ O, DALY A, PINTO A, et al. Natural protein tolerance and metabolic control in patients with hereditary tyrosinaemia type 1[J]. Nutrients, 2020, 12(4): 1148. DOI: 10.3390/nu12041148.
[34]	VAN SPRONSEN FJ, VAN RIJN M, MEYER U, et al. Dietary considerations in tyrosinemia type I[J]. Adv Exp Med Biol, 2017, 959: 197-204. DOI: 10.1007/978-3-319-55780-9_18.
[35]	ROSS KM, FERRECCHIA IA, DAHLBERG KR, et al. Dietary management of the glycogen storage diseases: Evolution of treatment and ongoing controversies[J]. Adv Nutr, 2020, 11(2): 439-446. DOI: 10.1093/advances/nmz092.
[36]	KISHNANI PS, AUSTIN SL, ABDENUR JE, et al. Diagnosis and management of glycogen storage disease type I: A practice guideline of the American College of Medical Genetics and Genomics[J]. Genet Med, 2014, 16(11): e1. DOI: 10.1038/gim.2014.128.
[37]	WELLING L, BERNSTEIN LE, BERRY GT, et al. International clinical guideline for the management of classical galactosemia: Diagnosis, treatment, and follow-up[J]. J Inherit Metab Dis, 2017, 40(2): 171-176. DOI: 10.1007/s10545-016-9990-5.
[38]	HAYASAKA K. Metabolic basis and treatment of citrin deficiency[J]. J Inherit Metab Dis, 2021, 44(1): 110-117. DOI: 10.1002/jimd.12294.
[39]	TRAN C. Inborn errors of fructose metabolism. What can we learn from them?[J]. Nutrients, 2017, 9(4): 356. DOI: 10.3390/nu9040356.
[40]	DI DATO F, SPADARELLA S, PUOTI MG, et al. Daily fructose traces intake and liver injury in children with hereditary fructose intolerance[J]. Nutrients, 2019, 11(10): 2397. DOI: 10.3390/nu11102397.