肝硬化患者营养评估面临的挑战
The Challenges of Nutritional Assessment in Cirrhosis.
作者信息
Molfino Alessio, Johnson Sheeva, Medici Valentina
机构信息
Department of Internal Medicine, Universita' La Sapienza, Rome, Italy.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California.
出版信息
Curr Nutr Rep. 2017 Sep;6(3):274-280. doi: 10.1007/s13668-017-0216-8. Epub 2017 Jul 18.
PURPOSE OF REVIEW
Nutritional status in patients with cirrhosis is very frequently associated with macro- and micronutrient deficiencies. Cirrhosis itself is the cause of malnutrition and nutritional deficiencies but these conditions have to be identified and addressed properly as they can worsen the prognosis of cirrhosis. The goals of this review are to 1) identify and describe the challenges associated with nutritional assessment in cirrhosis and 2) describe recent advancements when using clinical, laboratory, and instrumental tools in the evaluation of malnourished patients with liver diseases.
RECENT FINDINGS
The most promising tools for nutritional assessment in cirrhosis include the evaluation of body composition with phase angle obtained by bioelectrical impedance analysis, computed tomography transverse images at the level of third lumbar vertebra. The Royal-Free Hospital global assessment algorithm appears to be helpful but needs further validation.
SUMMARY
Nutritional assessment in cirrhosis is challenging as several factors, including edema, can interfere with it and because of lack of a validated gold standard. Regardless, nutritional assessment methods have been developed in recent years and should gain relevance in the clinical practice.
综述目的
肝硬化患者的营养状况常常与大量营养素和微量营养素缺乏相关。肝硬化本身是营养不良和营养缺乏的原因，但这些情况必须得到正确识别和处理，因为它们会使肝硬化的预后恶化。本综述的目的是：1）识别并描述与肝硬化营养评估相关的挑战；2）描述在评估营养不良的肝病患者时使用临床、实验室和仪器工具的最新进展。
最新发现
肝硬化营养评估最有前景的工具包括通过生物电阻抗分析获得的相位角评估身体成分、第三腰椎水平的计算机断层扫描横向图像。皇家自由医院全球评估算法似乎有帮助，但需要进一步验证。
总结
肝硬化的营养评估具有挑战性，因为包括水肿在内的几个因素会干扰评估，且缺乏经过验证的金标准。尽管如此，近年来已经开发出营养评估方法，并且应该在临床实践中得到更多应用。
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