Department of Internal Medicine, Fujita Health University, Aichi, Japan.
Hepatol Res. 2008 May;38(5):484-90. doi: 10.1111/j.1872-034X.2007.00300.x. Epub 2007 Nov 16.
Nutrition support for patients with liver cirrhosis, such as late evening snacks and branched-chain amino acids, has been demonstrated to be effective. However, the assessment of the malnutrition of liver cirrhosis is still a problem. The aim of this study was to assess the nutritional status of patients with liver cirrhosis due to hepatitis C virus by six methods and to test the sensitivity and specificity of these methods.
In total, 86 patients with liver cirrhosis due to hepatitis C virus were assessed for nutritional status by triceps skinfold thickness (TSF), arm muscle circumference (AMC), subjective global assessment (SGA), nutritional risk index (NRI), Maastricht index (MI), and instant nutritional assessment (INA).
Malnutrition was found in 11 (12.8%) patients by TSF, 15 (17.4%) by AMC, 22 (25.6%) by SGA, 52 (60.5%) by the NRI, 66 (76.7%) by the MI, and in 54 (62.8%) by INA. The MI detected malnutrition at a significantly higher rate compared with the other five methods. Sixty-two patients were diagnosed as malnourished by the combined index, which defines the patients as malnourished when any two of the NRI, MI, and INA also define them as malnourished. The misclassification rate compared with the combined indexes was significantly lower in the MI (4.7%) than in any of the TSF (59.3%), AMC (59.3%), SGA (46.5%), NRI (16.3%), and INA (14.0%).
The MI was the best single score to identify the patients who had malnutrition, including early stage, and may benefit from nutrition support.
对于肝硬化患者，如给予晚间点心和支链氨基酸的营养支持，已被证实是有效的。然而，肝硬化患者营养不良的评估仍然是一个问题。本研究旨在通过六种方法评估丙型肝炎病毒引起的肝硬化患者的营养状况，并测试这些方法的敏感性和特异性。
共对 86 例丙型肝炎病毒引起的肝硬化患者进行了三头肌皮褶厚度（TSF）、臂肌围（AMC）、主观整体评估（SGA）、营养风险指数（NRI）、马斯特里赫特指数（MI）和即时营养评估（INA）的营养状况评估。
11 例（12.8%）患者 TSF 营养不良，15 例（17.4%）患者 AMC 营养不良，22 例（25.6%）患者 SGA 营养不良，52 例（60.5%）患者 NRI 营养不良，66 例（76.7%）患者 MI 营养不良，54 例（62.8%）患者 INA 营养不良。MI 检测到的营养不良率明显高于其他五种方法。62 例患者根据联合指数被诊断为营养不良，该指数定义为当 NRI、MI 和 INA 中的任何两种也将患者定义为营养不良时，患者即为营养不良。MI 的分类错误率（4.7%）明显低于 TSF（59.3%）、AMC（59.3%）、SGA（46.5%）、NRI（16.3%）和 INA（14.0%）。
MI 是识别营养不良患者（包括早期）的最佳单一评分方法，可能受益于营养支持。
