白蛋白前体在肝硬化患者营养不良预测中的应用，以及低白蛋白前体水平患者营养支持的效果。
The use of prealbumin as a predictor of malnutrition in cirrhotic patients and the effect of nutritional support in patients with low prealbumin levels.
机构信息
Department of Internal Medicine, Erol Olçok Education and Research Hospital, Çorum, Turkey
Department of Gastroenterology, Faculty of Medicine, Hitit University, Çorum, Turkey
出版信息
Turk J Med Sci. 2020 Apr 9;50(2):398-404. doi: 10.3906/sag-1910-27.
BACKGROUND/AIM: Malnutrition is an important and commonly seen prognostic factor in patients with cirrhosis. The diagnosis of malnutrition in cirrhosis patients may be challenging, and an easily measured and widely usable marker is lacking. Prealbumin, however, is an easily measured marker. In the current study we measured prealbumin levels in cirrhotic patients with no clinically apparent malnutrition and used it as a malnutrition marker. Another aim of this study was to evaluate the effect of nutritional support on patient with low prealbumin levels.
MATERIALS AND METHODS
Fifty-two patients with Child A and Child B cirrhosis were selected for the study. Prealbumin levels were studied, and Child and MELD scores were calculated. Patients with prealbumin levels ˂180 mg/L were considered to have malnutrition, and two different types of nutritional products were given to these patients. The patients given nutritional support were investigated a month later, and parameters were compared.
RESULTS
According to the prealbumin threshold of 180 mg/L, malnutrition frequencies were 59.3% for Child A and 95% for Child B cirrhosis. After the provision of nutritional support statistically significant improvements in albumin and INR levels were detected. In addition, the MELD score decreased; however, it was not statistically significant (P: 0.088). A statistically significant decrease in the MELD score was only obtained in patients with Child B cirrhosis (P: 0.033). When the oral replacement therapies were investigated separately, a statistically significant decrease in MELD scores was detected with product 1 (P: 0.043).
CONCLUSION
Prealbumin can be used as an easily measured parameter for earlier detection of malnutrition in patients with cirrhosis and without clinically apparent malnutrition. Oral nutritional support, especially with products containing relatively high carbohydrate levels and low protein, may have a favorable effect on MELD scores.
背景/目的：营养不良是肝硬化患者的一个重要且常见的预后因素。肝硬化患者营养不良的诊断可能具有挑战性，并且缺乏易于测量和广泛使用的标志物。然而，前白蛋白是一种易于测量的标志物。在本研究中，我们测量了无明显临床营养不良的肝硬化患者的前白蛋白水平，并将其用作营养不良标志物。本研究的另一个目的是评估营养支持对低前白蛋白水平患者的影响。
材料和方法
选择 52 名 Child A 和 Child B 肝硬化患者进行研究。研究了前白蛋白水平，并计算了 Child 和 MELD 评分。前白蛋白水平<180mg/L 的患者被认为存在营养不良，并给予这两种不同类型的营养产品。一个月后对接受营养支持的患者进行调查，并比较参数。
结果
根据 180mg/L 的前白蛋白阈值，Child A 肝硬化的营养不良发生率为 59.3%，Child B 肝硬化的营养不良发生率为 95%。提供营养支持后，白蛋白和 INR 水平均有统计学显著改善。此外，MELD 评分降低；然而，这并不具有统计学意义（P：0.088）。仅在 Child B 肝硬化患者中，MELD 评分的统计学显著降低（P：0.033）。当分别研究口服替代疗法时，产品 1 的 MELD 评分有统计学显著降低（P：0.043）。
结论
前白蛋白可作为一种易于测量的参数，用于早期发现无明显临床营养不良的肝硬化患者的营养不良。口服营养支持，特别是使用含有相对高碳水化合物和低蛋白质的产品，可能对 MELD 评分产生有利影响。
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