Nishikawa Hiroki, Yoh Kazunori, Enomoto Hirayuki, Iwata Yoshinori, Kishino Kyohei, Shimono Yoshihiro, Hasegawa Kunihiro, Nakano Chikage, Takata Ryo, Nishimura Takashi, Aizawa Nobuhiro, Sakai Yoshiyuki, Ikeda Naoto, Takashima Tomoyuki, Ishii Akio, Iijima Hiroko, Nishiguchi Shuhei
From the Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Medicine (Baltimore). 2016 Jan;95(2):e2442. doi: 10.1097/MD.0000000000002442.
We aimed to elucidate the incidence of protein-energy malnutrition (PEM) in patients with chronic liver disease and to identify factors linked to the presence of PEM.A total of 432 patients with chronic liver disease were analyzed in the current analysis. We defined patients with serum albumin level of ≤3.5 g/dL and nonprotein respiratory quotient (npRQ) value using indirect calorimetry less than 0.85 as those with PEM. We compared between patients with PEM and those without PEM in baseline characteristics and examined factors linked to the presence of PEM using univariate and multivariate analyses.There are 216 patients with chronic hepatitis, 123 with Child-Pugh A, 80 with Child-Pugh B, and 13 with Child-Pugh C. Six patients (2.8%) had PEM in patients with chronic hepatitis, 17 (13.8%) in patients with Child-Pugh A, 42 (52.5%) in patients with Child-Pugh B, and 10 (76.9%) in patients with Child-Pugh C (P < 0.001). Multivariate analysis revealed that Child-Pugh classification (P < 0.001), age ≥64 years (P = 0.0428), aspartate aminotransferase (AST) ≥40 IU/L (P = 0.0023), and branched-chain amino acid to tyrosine ratio (BTR) ≤5.2 (P = 0.0328) were independent predictors linked to the presence of PEM. On the basis of numbers of above risk factors (age, AST, and BTR), the proportions of patients with PEM were well stratified especially in patients with early chronic hepatitis or Child-Pugh A (n = 339, P < 0.0001), while the proportions of patients with PEM tended to be well stratified in patients with Child-Pugh B or C (n = 93, P = 0.0673).Age, AST, and BTR can be useful markers for identifying PEM especially in patients with early stage of chronic liver disease.
我们旨在阐明慢性肝病患者中蛋白质 - 能量营养不良（PEM）的发生率，并确定与PEM存在相关的因素。本分析共纳入432例慢性肝病患者。我们将血清白蛋白水平≤3.5 g/dL且通过间接测热法测得的非蛋白呼吸商（npRQ）值小于0.85的患者定义为患有PEM。我们比较了PEM患者和非PEM患者的基线特征，并使用单因素和多因素分析检查了与PEM存在相关的因素。有216例慢性肝炎患者，123例Child-Pugh A级患者，80例Child-Pugh B级患者和13例Child-Pugh C级患者。慢性肝炎患者中有6例（2.8%）患有PEM，Child-Pugh A级患者中有17例（13.8%），Child-Pugh B级患者中有42例（52.5%），Child-Pugh C级患者中有10例（76.9%）（P < 0.001）。多因素分析显示，Child-Pugh分级（P < 0.001）、年龄≥64岁（P = 0.0428）、天冬氨酸转氨酶（AST）≥40 IU/L（P = 0.0023）以及支链氨基酸与酪氨酸比值（BTR）≤5.2（P = 0.0328）是与PEM存在相关的独立预测因素。基于上述风险因素（年龄、AST和BTR）的数量，PEM患者的比例得到了很好的分层，尤其是在早期慢性肝炎患者或Child-Pugh A级患者中（n = 339，P < 0.0001），而在Child-Pugh B级或C级患者中PEM患者的比例也倾向于得到很好的分层（n = 93，P = 0.0673）。年龄、AST和BTR可作为识别PEM的有用标志物，尤其是在慢性肝病早期患者中。
