肝硬化患者营养评价及饮食管理研究进展

doi:10.3969/j.issn.1672-5069.2023.04.038

摘要/Abstract

摘要： 目的多数肝硬化患者存在一定程度的营养不良,主要以蛋白质-热量营养不良为主。同时,由于肝硬化患者存在门静脉高压,导致胃肠道淤血水肿、腹水、肠道细菌过度生长、消化道出血、继发性感染等并发症,上述多种因素使得营养物质的摄入减少、吸收障碍、丢失过多,导致代谢紊乱加重,增加发生并发症和死亡风险。因而,在治疗肝硬化的过程中,营养支持占据重要的地位。本文主要阐述肝硬化患者的营养评价和饮食管理研究进展。

关键词: 肝硬化, 营养不良, 营养评估, 营养支持

Abstract: Objective Most patients with liver cirrhosis (LC) have a certain degree of malnutrition, mainly protein-calorie malnutrition. The portal hypertension in patients with LC can lead to gastrointestinal congestion and edema, ascites, overgrowth of intestinal bacteria, gastrointestinal bleeding, secondary infections, and other complications, resulting in reduced intake, absorption disorders and excessive loss of nutrients. It can also lead to metabolic disorders, with increased incidence of complications and risk of death. Therefore, nutritional support should be take into consideration during the treatment of patients with LC. In this article, we mainly focuses on the nutritional evaluation and diet management for them.

Key words: Liver cirrhosis, Malnutrition, Nutrition assessment, Nutritional support

李钟浙, 廖晖, 徐小平. 肝硬化患者营养评价及饮食管理研究进展[J]. 实用肝脏病杂志, 2023, 26(4): 601-604.

Li Zhongzhe, Liao Hui, Xu Xiaoping. Nutrition assessment and diet management in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2023, 26(4): 601-604.

参考文献

[1] 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南. 实用肝脏病杂志, 2019,22(6):770-786.
[2] Nishikawa H, Enomoto H, Nishiguchi S, et al. Sarcopenic obesity in liver cirrhosis: possible mechanism and clinical impact. Int J Mol Sci, 2021,22(4):1917.
[3] Sasidharan M, Nistala S, Narendhran RT, et al. Nutritional status and prognosis in cirrhotic patients. Trop Gastroenterol, 2012,33(4):257-264.
[4] Kalafateli M, Mantzoukis K, Choi Yau Y, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the model for end-stage liver disease score. J Cachexia Sarcopenia Muscle, 2017,8(1):113-121.
[5] Fernandes SA, Leonhardt LR, da Silva DM, et al. Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients. World J Hepatol, 2020,12(12):1276-1288.
[6] 杨晓玲, 张素梅. SGA、MNA和NRS2002评估失代偿期肝硬化患者营养状态应用价值分析. 实用肝脏病杂志, 2020,23(1):70-73.
[7] Georgiou A, Papatheodoridis GV, Alexopoulou A, et al. Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study. Br J Nutr, 2019,122(12):1368-1376.
[8] Sinclair M, Chapman B, Hoermann R, et al. Handgrip strength adds more prognostic value to the model for end-stage liver disease score than imaging-based measures of muscle mass in men with cirrhosis. Liver Transpl, 2019,25(10):1480-1487.
[9] Schweitzer L, Geisler C, Pourhassan M, et al. What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr, 2015,102(1):58-65.
[10] 石志文, 李娟, 曾欣, 等. L_3骨骼肌指数在疾病预后评估中的应用. 第二军医大学学报, 2019,40(4):420-425.
[11] Traub J, Reiss L, Aliwa B, et al. Malnutrition in patients with liver cirrhosis. Nutrients, 2021,13(2):540.
[12] Ribeiro HS, Mauricio SF, Antônio da Silva T, et al. Combined nutritional assessment methods to predict clinical outcomes in patients on the waiting list for liver transplantation. Nutrition, 2018,47:21-26.
[13] Maharshi S, Sharma BC, Srivastava S. Malnutrition in cirrhosis increases morbidity and mortality. J Gastroenterol Hepatol, 2015,30(10):1507-1513.
[14] Chaney A, Rawal B, Harnois D, et al. Nutritional assessment and malnutrition in patients with cirrhosis. Gastroenterol Nurs, 2020,43(4):284-291.
[15] Müller MJ, Böttcher J, Selberg O, et al. Hypermetabolism in clinically stable patients with liver cirrhosis. Am J Clin Nutr, 1999,69(6):1194-1201.
[16] Lai JC, Tandon P, Bernal W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American association for the study of liver diseases. Hepatology, 2021,74(3):1611-1644.
[17] Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol, 2019,70(1):172-193.
[18] Bajaj JS, Lauridsen M, Tapper EB, et al. Important unresolved questions in the management of hepatic encephalopathy: an ISHEN consensus. Am J Gastroenterol, 2020,115(7):989-1002.
[19] Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr, 2020,39(12):3533-3562.
[20] Palmese F, Bolondi I, Giannone FA, et al. The analysis of food intake in patients with cirrhosis waiting for liver transplantation: a neglected step in the nutritional assessment. Nutrients, 2019,11(10):2462.
[21] Mieszkowski J, Stankiewicz BE, Kochanowicz A, et al. Remote ischemic preconditioning reduces marathon-induced oxidative stress and decreases liver and heart injury markers in the serum. Front Physiol, 2021,12:731889.
[22] Toshikuni N, Arisawa T, Tsutsumi M. Nutrition and exercise in the management of liver cirrhosis. World J Gastroenterol, 2014,20(23):7286-7297.
[23] Properzi C, O'Sullivan TA, Sherriff JL, et al. Ad libitum mediterranean and low‐fat diets both significantly reduce hepatic steatosis: A randomized controlled trial. Hepatology, 2018,68(5):1741-1754.
[24] Baratta F, Pastori D, Polimeni L, et al. Adherence to mediterranean diet and non-alcoholic fatty liver disease: effect on insulin resistance. Am J Gastroenterol, 2017,112(12):1832-1839.
[25] Yaskolka Meir A, Rinott E, Tsaban G, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut, 2021,70(11):2085-2095.
[26] Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol, 2017,67(4):829-846.
[27] Ruiz-Margáin A, Macías-Rodríguez RU, Ríos-Torres SL, et al. Effect of a high-protein, high-fiber diet plus supplementation with branched-chain amino acids on the nutritional status of patients with cirrhosis. Rev Gastroenterol Mex (Engl Ed), 2018,83(1):9-15.
[28] Les I, Doval E, García-Martínez R, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. Am J Gastroenterol, 2011,106(6):1081-1088.
[29] 于健春, 陈伟, 江华, 等. 多种微量元素制剂临床应用专家共识. 中华外科杂志, 2018,56(3):168-176.
[30] 高纯, 李梦, 韦军民, 等. 复方氨基酸注射液临床应用专家共识. 肿瘤代谢与营养电子杂志, 2019,6(2):183-189.
[31] 段钟平, 杨云生. 终末期肝病临床营养指南. 中华肝脏病杂志, 2019,27(5):330-342.
[32] 侯维, 蒋朱明, 杨剑, 等. 慢性肝病患者肠外肠内营养支持与膳食干预专家共识. 中华肝胆外科杂志, 2017,23(2):73-81.