肝硬化中的营养不良：与病因和肝细胞功能障碍的关联。

MALNUTRITION IN CIRRHOSIS: ASSOCIATION WITH ETIOLOGY AND HEPATOCELLULAR DYSFUNCTION.

机构信息

Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Hepatologia, Porto Alegre, RS, Brasil.

Centro Metodista (IPA), Faculdade de Nutrição, Porto Alegre, RS, Brasil.

出版信息

Arq Gastroenterol. 2020 Oct-Dec;57(4):375-380. doi: 10.1590/S0004-2803.202000000-71.

DOI:10.1590/S0004-2803.202000000-71

PMID:33331472

Abstract

BACKGROUND

The protein-energy malnutrition alters the prognosis of patients with cirrhosis. Its prevalence may vary according to the etiology of liver disease, it´s severity and the evaluation of the method applied. The infection by the hepatitis C virus (HCV) and alcoholism are the main etiologies of cirrhosis and result in a significant morbidity and mortality.

OBJECTIVE

To evaluate the nutritional status of patients with cirrhosis according the liver disease etiology and severity.

METHODS

It is a prospective study, in which the sample was for convenience and consisted of patients with cirrhosis, infected by HCV or alcoholic etiology. The nutritional status evaluation was carried out through anthropometry, food consumption, bioelectrical impedance (BIA) and subjective global assessment (SGA). The anthropometric data evaluated were weight, height, body mass index (BMI), triceps skinfold (TSF), circumference of the arm (CA), non-dominant handshake strength (FAM) and the adductor pollicis muscle thickness (APM). Patients were classified according to the severity of liver disease, using the Child-Pugh and Model for End-stage Liver Diseases (MELD) scores.

RESULTS

Ninety patients with cirrhosis were evaluated, 47 with HCV and 43 with alcoholic etiology. The prevalence of protein-calorie malnutrition ranged from 10.9% to 54.3% in the HCV group and from 4.7% to 20.9% in the alcoholic group, depending on the method used for evaluation. The group with HCV infection presented a higher malnutrition prevalence in comparison to the alcoholic in the following evaluations: TSF (P<0.001), phase angle (PA) (P=0.016) and SGA (P=0.010). PA values were lower in patients with viral cirrhosis (5.68±1.05) when compared to those with alcoholic etiology (6.61±2.31) (P=0.016). When all patients were analyzed, regardless of etiology, an inversely correlation was observed among Child-Pugh score and PA values (P=0.018).

CONCLUSION

HCV cirrhosis showed worse nutritional parameters in comparison to alcoholic etiology; however, the PA was associated with worse liver function in both etiologies.

摘要

背景

蛋白质能量营养不良会改变肝硬化患者的预后。其患病率可能因肝病的病因、严重程度和所应用评估方法的不同而有所差异。丙型肝炎病毒（HCV）感染和酗酒是肝硬化的主要病因，会导致显著的发病率和死亡率。

目的

根据肝病病因和严重程度评估肝硬化患者的营养状况。

方法

这是一项前瞻性研究，采用便利抽样法，选取 HCV 感染或酒精性病因所致肝硬化患者作为研究对象。营养状况评估通过人体测量学、食物摄入、生物电阻抗（BIA）和主观全面评估（SGA）进行。评估的人体测量学数据包括体重、身高、体重指数（BMI）、三头肌皮褶厚度（TSF）、上臂周长（CA）、非优势手握力（FAM）和拇指内收肌厚度（APM）。根据 Child-Pugh 和终末期肝病模型（MELD）评分对患者进行肝功能严重程度分级。

结果

共评估了 90 例肝硬化患者，其中 47 例为 HCV 感染，43 例为酒精性病因。根据评估方法的不同，HCV 组的蛋白质-热量营养不良患病率为 10.9%至 54.3%，酒精组为 4.7%至 20.9%。与酒精性病因相比，HCV 感染组在以下评估中表现出更高的营养不良患病率：TSF（P<0.001）、相位角（PA）（P=0.016）和 SGA（P=0.010）。病毒性肝硬化患者的 PA 值（5.68±1.05）低于酒精性病因患者（6.61±2.31）（P=0.016）。当所有患者，无论病因如何，均进行分析时，Child-Pugh 评分与 PA 值之间呈负相关（P=0.018）。