Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany.
Institute for Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany.
Clin Nutr. 2015 Dec;34(6):1122-7. doi: 10.1016/j.clnu.2014.11.007. Epub 2014 Nov 18.
BACKGROUND & AIMS: Malnutrition is a common, hence frequently underdiagnosed condition in patients with liver cirrhosis as well as in patients with cancer and has been shown to have a negative impact on survival in these patients. Frequently applied screening tools including anthropometric measurements or laboratory parameters to screen for malnutrition are not suitable for patients with liver cirrhosis with additional pathophysiological mechanisms leading to hypoalbuminemia and edema. Prospective data on the prevalence and prognostic impact of malnutrition in patients with HCC are scarce.
Fifty-one consecutive patients with hepatocellular carcinoma were prospectively enrolled into this study and screened for malnutrition by anthropometric measurements, the MNA score, the NRS score, laboratory work-up, and BIA measurement. The results of the different screening tools were compared to each other and with the BIA assessment and correlated with the outcome of patients.
The calculation of a body mass index (BMI) was not suitable to identify malnourished patients with HCC. The MNA identified 19, the NRS score 17 patients at a risk for malnutrition. BIA revealed a reduction in relative body cell mass in 12 patients. Univariate Cox regression analyses identified tumor stage, MNA score, and phase angle obtained by BIA as significant factors with influence on survival. Multivariate analyses confirmed the phase angle at a cut-off of 4.8 to be an independent factor.
A significant proportion of patients with HCC is malnourished or at risk for malnutrition. Screening questionnaires and BIA measurement are superior to pure anthropometric measurements to identify the condition that negatively influences survival. The phase angle derived from body impedance analysis is an independent prognostic factor in patients with HCC.
营养不良是肝硬化患者、癌症患者常见且常被漏诊的病症，已有研究表明其会对患者的生存产生负面影响。目前常用的营养不良筛查工具，包括人体测量学指标或实验室参数，并不适用于伴有白蛋白减少和水肿等其他病理生理机制的肝硬化患者。关于 HCC 患者营养不良的患病率和预后影响的前瞻性数据较为缺乏。
本研究前瞻性纳入了 51 例连续的肝细胞癌患者，通过人体测量学指标、MNA 评分、NRS 评分、实验室检查和 BIA 测量筛查营养不良。将不同筛查工具的结果相互比较，并与 BIA 评估结果及患者的预后相关联。
计算体重指数（BMI）不适合识别患有 HCC 的营养不良患者。MNA 识别出 19 例、NRS 评分识别出 17 例有营养不良风险的患者。BIA 显示 12 例患者相对体细胞质量减少。单因素 Cox 回归分析确定肿瘤分期、MNA 评分和 BIA 获得的相位角是对生存有影响的显著因素。多因素分析证实，相位角在 4.8 的截点是一个独立的因素。
相当一部分 HCC 患者存在营养不良或有营养不良风险。筛查问卷和 BIA 测量比单纯的人体测量学指标更能识别出对生存有负面影响的情况。来自体阻抗分析的相位角是 HCC 患者的一个独立预后因素。
