Norman K, Valentini L, Lochs H, Pirlich M
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité - Universitätsmedizin Berlin.
Z Gastroenterol. 2010 Jul;48(7):763-70. doi: 10.1055/s-0029-1245388. Epub 2010 Jul 6.
Malnutrition with loss of muscle is common in patients with liver cirrhosis and has negative impact on morbidity and mortality. The aetiology of malnutrition is multifactorial and includes inflammation, early onset of gluconeogenesis due to impaired glycogen storage and sometimes hypermetabolism. Reduced nutritional intake, however, plays the most important role in the pathogenesis of malnutrition. There is, however, ample evidence that nutritional intake and therapy are inadequate in liver cirrhosis although studies have clearly shown that dietary counselling and nutritional therapy with oral supplements improve intake in these patients. Protein requirement is considered to be increased in liver cirrhosis and high protein intake has been shown to be well tolerated and associated with an improvement of liver function and nutritional status. Protein intolerance on the other hand is uncommon and hepatic encephalopathy can thus rarely be attributed to high protein consumption. Recommendations for general protein restriction must therefore be considered obsolete and rather a risk factor for an impaired clinical outcome. Furthermore, the administration of late evening meals is highly beneficial in patients with liver disease since the rapid onset of the overnight catabolic state is counteracted. The serum concentration of branched-chain amino acids (BCAA) is decreased in patients with liver cirrhosis and long-term supplementation of BCAA has been shown to improve nutritional status and prolong event-free survival and quality of life.
肌肉量减少的营养不良在肝硬化患者中很常见，对发病率和死亡率有负面影响。营养不良的病因是多因素的，包括炎症、由于糖原储存受损导致的糖异生过早开始以及有时的高代谢状态。然而，营养摄入减少在营养不良的发病机制中起最重要作用。然而，有充分证据表明，肝硬化患者的营养摄入和治疗不足，尽管研究清楚地表明，饮食咨询和口服补充剂的营养治疗可改善这些患者的摄入量。肝硬化患者的蛋白质需求量被认为增加，高蛋白摄入已被证明耐受性良好，并与肝功能和营养状况的改善相关。另一方面，蛋白质不耐受并不常见，因此肝性脑病很少可归因于高蛋白摄入。因此，一般蛋白质限制的建议必须被认为过时，而且更是临床结局受损的一个危险因素。此外，对肝病患者给予晚餐非常有益，因为可抵消夜间分解代谢状态的快速出现。肝硬化患者的支链氨基酸（BCAA）血清浓度降低，长期补充BCAA已被证明可改善营养状况、延长无事件生存期并提高生活质量。
