住院肝硬化患者营养风险评估与临床转归的相关性研究

doi:10.16138/j.1673-6087.2025.05.05

摘要/Abstract

摘要：

目的：评估肝硬化住院患者的营养风险状况，探讨其与临床转归的关系。方法：选择2020年6月至2022年6月收治于上海市某三级甲等医院感染科的401例肝硬化患者为研究对象，采用皇家自由医院营养优先筛查工具（the Royal Free Hospital-nutritional prioritizing tool，RFH-NPT）进行营养风险评价，比较不同营养风险肝硬化患者在一般资料、疾病特征、实验室指标和临床转归方面的差异。结果：401例患者中86例（21.45%）存在中度营养风险，122例（30.42%）为高度营养风险；不同营养风险患者的病因分类、终末期肝病模型（model for end-stage liver disease，MELD）评分、Child-Pugh分级、腹水量以及血清白蛋白、前白蛋白、甘油三酯和血红蛋白等实验室指标差异均有统计学意义（P<0.05）；随营养风险等级升高，感染、上消化道出血和电解质紊乱的发生率上升，日常生活活动能力评分下降（P<0.05）。结论：存在中高度营养风险的肝硬化患者较低风险者肝功能损害更严重，并发症发生率高且临床预后差。

关键词: 肝硬化, 营养风险, 临床转归, RFH-NPT

Abstract:

Objective To evaluate the nutritional risk in hospitalized patients with cirrhosis and explore the relationship between nutritional risk and clinical prognosis. Methods A total of 401 patients with cirrhosis admitted to the infectious diseases department of a grade-Ⅲ hospital in Shanghai from June 2020 to June 2022 were selected as study subjects. The nutritional risk assessment was performed using the Royal Free Hospital-nutrition prioritizing tool (RFH-NPT), and the general information, disease status, laboratory indicators, and clinical prognosis of cirrhosis patients with different nutritional risks were compared. Results In 401 patients, 86 (21.45%) cases had moderate nutritional risk, and 122 (30.42%) cases had high nutritional risk. There were differences in etiological classification, model for end-stage liver disease (MELD) score, Child-Pugh grade, abdominal water volume and laboratory indexes of serum albumin, prealbumin, triglyceride and hemoglobin among patients with different nutritional risks (P < 0.05). With the increase of nutritional risk grade, the incidence of infection, upper gastrointestinal bleeding and electrolyte disturbance increased, and the score of activity of daily living decreased (P < 0.05). Conclusions Cirrhosis patients with moderate to high nutritional risk have severer liver function impairment, high complication rate and poor clinical prognosis compared to those at lower risk.

Key words: Liver cirrhosis, Nutritional risk, Clinical outcome, RFH-NPT

中图分类号:

R575.2

王琳, 项晓刚, 李丽, 钱珠萍. 住院肝硬化患者营养风险评估与临床转归的相关性研究[J]. 内科理论与实践, 2025, 20(05): 376-380.

WANG Lin, XIANG Xiaogang, LI Li, QIAN Zhuping. Study on correlation between nutritional risk assessment and clinical outcome in hospitalized patients with cirrhosis[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(05): 376-380.

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项目	低风险（n=193）	中风险（n=86）	高风险（n=122）	x²/F	P
性别[n (%)]
男性	140（75.54）	58（67.44）	86（70.49）	0.757	0.685
女性	53（24.46）	28（32.56）	36（29.51）
年龄(岁)	56.26±12.19	54.19±13.63	55.39±11.49	0.858	0.425
病因[n (%)]
病毒性肝炎	141（73.06）	51（59.30）	74（60.66）	10.376	0.031
酒精性肝硬化	16（8.29）	7（8.14）	12（9.84）
自身免疫性肝硬化	9（4.66）	6（6.98）	12（9.84）
其他	27（13.99）	22（25.58）	24（19.66）
MELD评分	11.60±5.19	14.26±5.71	14.83±6.02	14.757	0.001
Child-Pugh分级[n (%)]
A级	99（51.30）	9（10.47）	17（13.93）	80.915	0.000
B级	76（39.38）	45（52.33）	67（54.92）
C级	18（9.32）	32（37.20）	38（31.15）
腹水量[n (%)]
无	140（72.54）	11（12.79）	40（32.79）	111.194	0.000
少量（<3 cm）	34（17.62）	30（34.88）	30（24.59）
中量（3~10 cm）	15（7.77）	30（34.88）	30（24.59）
大量（＞10 cm）	4（2.07）	15（17.45）	22（18.03）
ALB(g/L)	33.69±6.37	29.07±5.61	30.06±5.69	23.314	0.000
PAB(mg/L)	126.08±63.57	86.99±44.83	94.84±54.55	18.564	0.000
TC(mmol/L)	3.69±1.23	3.55±2.04	3.45±1.48	0.876	0.417
TG(mmol/L)	1.22±0.69	1.10±0.56	1.44±1.29	3.588	0.029
Hb(g/L)	123.60±22.17	113.23±23.90	111.30±24.09	12.520	0.000

项目	低风险（n =193）	中风险（n =86）	高风险（n =122）	x²/F	P
生存率[n (%)]	189（97.93）	86（100）	118（96.72）	2.785	0.248
住院时间(d)	20.82±23.76	22.40±16.72	25.40±18.77	1.763	0.173
并发症[n (%)]
感染	45（23.32）	24（27.91）	50（40.98）	11.344	0.003
上消化道出血	11（5.70）	7（8.14）	17（13.93）	6.411	0.041
肾功能不全	50（25.91）	20（23.26）	30（24.59）	0.235	0.889
电解质紊乱	51（26.42）	34（39.53）	56（45.90）	13.356	0.001
轻微型肝性脑病	86（44.56）	38（44.19）	64（52.46）	2.193	0.334
并发症总体发生率	132（68.39）	68（79.07）	106（86.89）	14.600	0.001
BI	98.11±7.51	96.86±9.11	94.96±13.57	3.675	0.026