慢性肝病的营养评估与治疗*

doi:10.3969/j.issn.1672-5069.2018.02.048

摘要/Abstract

摘要： 慢性肝病患者很容易发生营养不良,并因此增加不良预后风险,但有关肝病营养不良的本质问题尚认识不够,且缺乏统一的诊断标准,个体化的营养干预和支持措施难以量化评估效果。针对这些问题,本文就营养不良评估方法、常见慢性肝病营养代谢特点和营养治疗进展做一介绍,希望能对慢性肝病的临床营养干预有所启示。

关键词: 慢性肝病, 营养, 评估, 治疗

Abstract: Patients with chronic liver diseases are inclined to have malnutrition that would increase the risks of poor prognosis,but the mechanism of malnutrition in liver disease is still not well known. The individualized nutritional intervention and nutrients supplement are also hard to be quantitative assessed. In this review,the common assessment methods of malnutrition,nutrient and metabolic features in patients with chronic liver diseases,and advances of nutritional therapy in liver diseases are reviewed,so as to give some enlightenment to the clinical nutrition intervention in chronic liver diseases.

Key words: Chronic liver diseases, Nutrition, Assessment, Treatment

王艳欣综述, 于红卫, 朱跃科审校. 慢性肝病的营养评估与治疗*[J]. 实用肝脏病杂志, 2018, 21(2): 317-320.

Wang Yanxin, Yu Hongwei, Zhu Yueke. Nutritional assessment and treatment in patients with chronic liver diseases[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(2): 317-320.

参考文献

[1] Kerwin AJ,Nussbaum MS.Adjuvant nutrition management of patients with liver failure,including transplant. Surg Clin North Am,2011,91:565-578.
[2] Naqvi IH,Mahmood K,Salekeen S,et al.Determining the frequency and severity of malnutrition and correlating it with the severity of liver cirrhosis. Turk J Gastroenterol,2013,24(5): 415-422.
[3] Tsiaousi ET,Hatzitolios AI,Trygonis SK,et al.Malnutrition in end stage liver disease:recommendations and nutritional support. J Gastroenterol Hepatol,2008,23(4):527-533.
[4] Everson GT.MELD:the answer or just more questions. Gastroenterology,2003,45:251-254.
[5] 蒋朱明,陈伟,朱赛楠,等. 我国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查. 中国临床营养杂志,2008,16(6):335-337.
[6] Ursula G,Kyle A,Michel P,et al.Comparision of tools for nutritional assessment and screening at hospital admission:A population study. Clin Nutr,2006,25(3):409-417.
[7] Kondrup J,Rasmussen H,Hamberg O,et a1. Nutritional risk screening(NRS2002):a new method based on an analysis of controlled clinical trials. Clin Nutr,2003,22(3):321-336.
[8] Fontaine E,Müller MJ.Adaptive alterations in metabolism: practical consequences on energy requirements in the severely ill patient. Curr Opin Clin Nutr Metab Care,2011,14(2):171-175.
[9] Bauer JM,Kaiser MJ,Anthony P,et al.The mini nutritionalassessment-its history,Today’s practice,and future perspectives. Nutr Clin Pract,2008,23(4):388-396.
[10] Purnak T,Yilmaz Y.Liver disease and malnutrition. Best Pract Res Clin Gastroenterol,2013,27(4):619-629.
[11] Ismail FW,Khan RA,Kamani L,et al.Nutritional status in patients with hepatitis C. J Coll Physicians Surg Pak,2012,22(3):139-142.
[12] Meng QH,Yu HW,Li J,et al.Inadequate nutritional intake and protein-energy malnutrition involved in acute and chronic viral hepatitis Chinese patients especially in cirrhosis patients. Hepatogastroenterology,2010,57,851.
[13] Meng QH,Wang JH,Yu HW,et al.Resting energy expenditure and substrate metabolism in Chinese patients with acute or chronic hepatitis B or liver cirrhosis. Intern Med,2010,49(19):2085-2091.
[14] Shlomai A,Paran N,Shaul Y.PGC-1 alpha controls hepatitis B virus through nutritional signals. Proc Natl Acad Sci USA,2006,103(43):16003-16008.
[15] Bitetto D,Bortolotti N,Falleti E,et al.Vitamin A deficiency is associated with hepatitis C virus chronic infection and with unresponsiveness to interferon-based antiviral therapy. Hepatology,2013,57(3):925-933.
[16] Peres WA,Chaves GV,Goncalves JC,et al.Vitamin A deficiency in patients with hepatitis C virus-related chronic liver disease. Br J Nutr,2011,106:1724-1731.
[17] Gundhng F,Schepp W.Nutrition in liver cirrhosis:diagnostic aspects and treatment. Dtsch Med Wochensehr,2008,(33):846-851.
[18] Bianchi G,Marzocchi R,Lorusso C,et al.Nutritional treatment of chronic liver failure. Hepatology,2008,38(15):93-101.
[19] Kalaitzakis E,Simrén M,OIsson R,et a1. Gastrointestinal symptoms in patients with liver cirrhosis:associations with nutritional status and health-related quailty of life. Scand J Gastroenterol,2006,41(12):1464-1472.
[20] Gundling F,Teich N,Strebel HM,et al.Nutrition in liver cirrhosis. Med Klin(Munich),2007,102(6):435-444.
[21] Cheung K,Lee SS,Raman M.Prevalence and mechanisms of malnutrition in patients with advanced liver disease,and nutrition management strategies. Clin Gastroenterol Hepatol,2012,10(2):117-125.
[22] Cabré E,Gassull MA.Nutrition in liver disease. Curr Opin Clin Nutr Metab Care,2005,8(5):545-551.
[23] 赵娟,李娟,于红卫,等. 乙型肝炎肝硬化合并2型糖尿病病人能量代谢特点的研究. 肠外与肠内营养,2015,22(1):6-9.
[24] 王金环,李娟,于红卫,等. 酒精性肝硬化病人能量代谢和临床特点. 肠外与肠内营养,2014,21(4):201-204.
[25] Plauth M,Cabré E,Riggio O,et al.ESPEN guidelines on eternal nutrition:Liver disease. Clin Nutr,2006,25:285-294.
[26] ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr,2002,26(2):144.
[27] 曹海霞,范建高. 肝硬化患者营养评估及营养支持治疗.实用肝脏病杂志,2014,17(4):459-462.
[28] Takeshita S,Ichikawa T,Nakao K,et al.A snack enriched with oral branched-chain amino acids prevents a fall in albumin in patients with liver cirrhosis undergoing chemoembolization for hepatocellular carcinoma. Nutr Res,2009,29(2):89-93.
[29] García-de-Lorenzo A,Ortíz-Leyba C,Planas M,et al. Parenteral administration of different amounts of branch-chain amino acids in septic patients:clinical and metabolic aspects. Crit Care Med,1997,25(3):418-424.
[30] Ndraha S,Hasan I,Simadibrata M.The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition. Acta Med Indones,2011,43(1):18-22.
[31] 孟庆华,于红卫,冯岩梅,等. 慢性重型病毒性肝炎患者的能量代谢特点及相关性研究. 中华医学杂志,2007,87(42):2982-2985.
[32] 范春蕾,吴燕京,丁惠国,等. 慢性重型病毒性肝炎的能量代谢及糖、蛋白质、脂肪氧化. 中国临床营养杂志,2006,14(2):111-114.
[33] Plauth M,Cabré E,Campillo B,et al.ESPEN guidelines on parenteral nutrition:Hepatology. Clin Nutr,2009,28(4):436-444.
[34] 中华医学会感染病学分会肝衰竭与人工肝学组和肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南.实用肝脏病杂志,2013,16(3):210-216.
[35] Heller AR,Rossel T,Cottschlich B,et al.Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer,2004,111(4):611-616.