Kim Hyung Keun, Oh Hyun Jong, Nam Sun Woo, Choi Jong Young, Cho Se Hyun, Yoon Seung Kyu, Han Jun Yeol, Yang Jin Mo, Han Nam Ik, Ahn Byung Min, Choi Sang Wook, Kim Jae Kwang, Lee Young Suk, Chung Kyu Won, Sun Hee Sik
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Gastroenterol. 2006 Jan;47(1):44-51.
BACKGROUND/AIMS: Protein-calorie malnutrition is a common complication in cirrhosis. Protein restriction for the treatment of hepatic encephalopathy (HE) may cause disease progression and poor prognosis. Therefore, we evaluated important clinical parameters for nutritional state in cirrhotic patients with or without HE to predict the development of HE.
Twenty-two cirrhotic patients were divided into two groups; group A-13 patients without HE and group B-9 patients with HE. Clinical and biochemical parameters, serum proteins {serum albumin, insulin-like growth factor-1 (IGF-1), transferrin, leptin, etc}, immunologic parameters and anthropometry were measured.
Child-Pugh score and Model for End-stage Liver Disease (MELD) scale were higher in group B (p<0.01). After correction of various factors affecting nutritional assessment, especially of Child-Pugh score and MELD scale, leptin was higher in group B (p<0.05). There was no difference in anthropometric measurements. Transferrin correlated inversely with MELD scale in group A (p<0.01). IGF-1 correlated inversely with total lymphocyte count in group B (p<0.05). Leptin correlated with Child-Pugh scores, total lymphocyte count and mid-arm muscle circumference in group A (p<0.05, p<0.05 and p<0.05, respectively), and correlated inversely with CD8 in group B (p<0.05).
Leptin level is higher in patients with HE, and further studies for parameters of nutrition to predict HE in many cirrhotic patients will be needed.
背景/目的：蛋白质-热量营养不良是肝硬化常见的并发症。限制蛋白质用于治疗肝性脑病（HE）可能会导致疾病进展和预后不良。因此，我们评估了有或无HE的肝硬化患者营养状况的重要临床参数，以预测HE的发生。
22例肝硬化患者分为两组；A组-13例无HE患者，B组-9例有HE患者。测量临床和生化参数、血清蛋白（血清白蛋白、胰岛素样生长因子-1（IGF-1）、转铁蛋白、瘦素等）、免疫参数和人体测量指标。
B组的Child-Pugh评分和终末期肝病模型（MELD）量表更高（p<0.01）。校正影响营养评估的各种因素后，尤其是Child-Pugh评分和MELD量表后，B组的瘦素更高（p<0.05）。人体测量指标无差异。A组中转铁蛋白与MELD量表呈负相关（p<0.01）。B组中IGF-1与总淋巴细胞计数呈负相关（p<0.05）。A组中瘦素与Child-Pugh评分、总淋巴细胞计数和上臂中部肌肉周长相关（分别为p<0.05、p<0.05和p<0.05），而在B组中与CD8呈负相关（p<0.05）。
HE患者的瘦素水平更高，需要对更多肝硬化患者预测HE的营养参数进行进一步研究。
