肝衰竭营养代谢特点及营养支持的研究进展

郭金; 石春霞; 邓威; 陈倩; 龚作炯

doi:10.3969/j.issn.1001-5256.2022.03.043

肝衰竭营养代谢特点及营养支持的研究进展

DOI: 10.3969/j.issn.1001-5256.2022.03.043

武汉大学人民医院感染科，武汉 430060

基金项目:

国家自然科学基金 (82070609)

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：郭金负责课题设计，资料分析，撰写论文；石春霞、邓威、陈倩参与收集数据，修改论文；龚作炯负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
龚作炯，zjgong@163.com

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出版历程
- 收稿日期: 2021-07-16
- 录用日期: 2021-08-16
- 出版日期: 2022-03-20

Research advances in the features of nutrition metabolism and nutritional support in liver failure

Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan 430060, China

Research funding:

National Natural Science Foundation of China (82070609)

More Information

Corresponding author: GONG Zuojiong, zjgong@163.com(ORCID: 0000-0002-4676-5856)

摘要

摘要: 肝脏是机体进行物质代谢的主要场所，在多种因素引起严重肝损伤时，其合成、代谢以及生物转化功能会出现明显障碍。总结了肝衰竭时糖、氨基酸、脂质等营养物质代谢的特点，以及营养不良的评估和临床干预的措施。对于肝功能衰竭患者应尽早识别并及时纠正营养不良，以改善能量代谢及炎症状态，提高患者生存率。
- 肝功能衰竭 /
- 能量代谢 /
- 营养支持
Abstract: The liver is the main place for metabolism in human body, and when severe liver injury is induced by various factors, there will be disorders in the functions of synthesis, metabolism, and biological conversion. This article summarizes the features of the metabolism of nutrients such as glucose, amino acids, and lipids in the presence of liver failure, as well as the assessment of malnutrition and clinical interventions. For patients with liver failure, it is of great importance to identify and correct malnutrition in a timely manner, so as to improve energy metabolism and inflammation and increase survival rate.
- Liver Failure /
- Energy Metabolism /
- Nutritional Support

HTML全文

表 1 营养不良的评估工具和方法

筛查工具	评估内容	优点	缺点
BMI	体质量/身高(kg/m²)	简单易行	易受水钠潴留(如腹水)等干扰因素影响
上臂肌围	上臂围(肱三头肌皮褶厚度×0.314)	简单易行，不受水钠潴留的干扰	与预后关系的研究目前局限于男性
主观全面评价法	饮食、体质量变化、胃肠道症状等6个方面	简单易行	主观性强
英国皇家自由医院-营养优先工具量表	饮食、体质量变化、并发症情况等临床问题	简单易行	易受主观因素干扰
握力	骨骼肌收缩功能	简单易行，敏感度高	特异度低，只能间接反映肌肉容积
生物电阻抗分析	分段检测肢体电阻抗以明确非脂肪质量	简单易行，低成本	易受机体水合状态影响
骨骼肌指数	CT测量第3腰椎腰大肌及脊柱旁、腹壁骨骼肌总横截面积，计算其与身高比值(cm²/m²)	可量化肌肉减少程度	经济成本、辐射问题
全身双能X线吸收测量法	测量骨密度、脂肪量、非脂肪质量	排除了水等混杂因素的影响	经济成本、辐射问题
生化评估	血清白蛋白、前白蛋白、转铁蛋白、视黄醇蛋白	可用于营养状态监测	蛋白水平可能会受到肝损伤等因素的影响

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