肝泡型包虫病患者的术前营养评估。
Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis.
机构信息
Department of Hepatobiliary Surgery (2), the Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Northeast Sichuan Acute Pancreatic Research Center, North Sichuan Medical College, Nanchong, China.
出版信息
PLoS One. 2020 Feb 24;15(2):e0229396. doi: 10.1371/journal.pone.0229396. eCollection 2020.
OBJECTIVE
This study is aimed at determining the preoperative nutritional status of patients with hepatic alveolar echinococcosis (HAE), and subsequently establish a concise and reasonable nutritional evaluation indicator. The established evaluation method could be used for clinical preoperative risk assessment and prediction of post-operation recovery.
METHODS
The basic patient information on height, body weight, BMI and hepatic encephalopathy of 93 HAE patients were examined. Subsequently, abdominal ultrasonography, blood coagulation and liver function tests were done on the patients. Liver function was assessed using the Child-Pugh improved grading method while nutritional status was evaluated using the European Nutrition Risk Screening 2002 (NRS 2002) method. Additional parameters including hospitalization time, the hemoglobin (HGB) level on the 3rd day after the operation, and the number of postoperative complications of HAE patients were also recorded.
RESULTS
The NRS 2002 score was negatively correlated with body weight, body mass index (BMI)and albumin (ALB) (P<0.01), and positively correlated with the transverse and longitudinal diameters of the lesions (P<0.01). A worse grading of liver function was associated with a low ALB and a high NRS 2002 score (P<0.01). Results of the NRS 2002 score indicate that the hospitalization time of the normal nutrition group was significantly shorter than that of the malnourished group (P < 0.05). The HGB level of the control group on the 3rd day after the operation was significantly higher than that of the malnourished group (P < 0.05), and the number of postoperative complications was lower than that of malnutrition group (P < 0.05).
CONCLUSION
Malnutrition is common in HAE patients. The nutritional status of HAE patients is related to many clinical factors, such as Child-Pugh classification of liver function, size of the lesion, and ALB among others. Although both BMI and ALB can be used as primary screening indicators for malnutrition in HAE patients, NRS 2002 is more reliable and prudent in judging malnutrition in HAE patients. Therefore, BMI and ALB are more suitable for preoperative risk assessment and prediction of postoperative recovery.
目的
本研究旨在确定肝泡型包虫病（HAE）患者的术前营养状况，并建立简洁合理的营养评估指标。该评估方法可用于临床术前风险评估和术后恢复预测。
方法
检查 93 例 HAE 患者的身高、体重、BMI 和肝性脑病等基本信息。然后对患者进行腹部超声、凝血和肝功能检查。采用 Child-Pugh 改良分级法评估肝功能，欧洲营养风险筛查 2002（NRS 2002）法评估营养状况。记录 HAE 患者的住院时间、术后第 3 天血红蛋白（HGB）水平和术后并发症发生情况等其他参数。
结果
NRS 2002 评分与体重、体重指数（BMI）和白蛋白（ALB）呈负相关（P<0.01），与病变的横径和长径呈正相关（P<0.01）。肝功能分级越差，ALB 越低，NRS 2002 评分越高（P<0.01）。NRS 2002 评分结果表明，正常营养组的住院时间明显短于营养不良组（P<0.05）。对照组术后第 3 天的 HGB 水平明显高于营养不良组（P<0.05），术后并发症数低于营养不良组（P<0.05）。
结论
HAE 患者普遍存在营养不良。HAE 患者的营养状况与肝功能 Child-Pugh 分级、病变大小、ALB 等多种临床因素有关。虽然 BMI 和 ALB 均可作为 HAE 患者营养不良的初步筛查指标，但 NRS 2002 更可靠、更审慎地判断 HAE 患者的营养不良情况。因此，BMI 和 ALB 更适合用于术前风险评估和预测术后恢复。
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