Baki Jad, Brown Patrick, Tapper Elliot B
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Curr Hepatol Rep. 2020 Jun;19(2):71-77. doi: 10.1007/s11901-020-00513-1. Epub 2020 Apr 22.
Ascites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium-restriction and high-protein diet are considered standard of care. However, their evidence base is limited. We performed a systematic review of randomized trials of nutritional interventions for ascites.
Increasing consumption of calories and protein alone was ineffective. Studies reached contradictory conclusions regarding sodium restriction in patients taking combination diuretics. Intravenous amino acid infusion alone did not improve outcomes, peripheral parenteral nutrition did not improve outcomes except alone but reduced mortality in conjunction with branched-chain amino acid evening snack.
Patients may benefit from sodium restriction and a protein-rich evening snack. Future trials should prioritize standardizing nutritional targets and tailoring interventions to the specific needs of patients including the socioeconomic factors impacting adherence.
腹水是肝硬化常见的严重并发症。诸如限钠和高蛋白饮食等营养干预措施被视为标准治疗方法。然而，其证据基础有限。我们对腹水营养干预的随机试验进行了系统综述。
仅增加热量和蛋白质的摄入量无效。对于联合使用利尿剂的患者，关于限钠的研究得出了相互矛盾的结论。单独静脉输注氨基酸并未改善预后，外周肠外营养除单独使用外未改善预后，但与支链氨基酸晚间加餐联合使用可降低死亡率。
患者可能从限钠和富含蛋白质的晚间加餐中获益。未来的试验应优先标准化营养目标，并根据患者的具体需求（包括影响依从性的社会经济因素）调整干预措施。
