肝硬化患者营养不良和衰弱的评估与临床管理

张一骏; 张茜; 罗新华

doi:10.3969/j.issn.1001-5256.2022.07.035

肝硬化患者营养不良和衰弱的评估与临床管理

DOI: 10.3969/j.issn.1001-5256.2022.07.035

张一骏¹,
张茜²,
罗新华^3, , ,

1.
贵州医科大学附属医院感染科，贵阳 550000
2.
贵州省人民医院感染科，贵阳 550000
3.
贵州医科大学附属人民医院感染科，贵阳 550000

基金项目:

贵州省科学技术基金重点项目 (Qiankehe Basis-ZK[2021] Priority013)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：张一骏负责撰写文章; 张茜参与修改文章内容; 罗新华参与文章的最终定稿。

详细信息

通信作者:
罗新华，luoxh09@163.com

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出版历程
- 收稿日期: 2021-11-18
- 录用日期: 2021-12-26
- 出版日期: 2022-07-20

Assessment and clinical management of malnutrition and asthenia in patients with liver cirrhosis

1.
Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
2.
Department of Infectious Diseases, Guizhou Provincial People's Hospital, Guiyang 550000, China
3.
Department of Infectious Diseases, The Affiliated People's Hospital of Guizhou Medical University, Guiyang 550000, China

Research funding:

Major Project of Science and Technology Fund of Guizhou Province (Qiankehe Basis-ZK[2021] Priority013)

More Information

Corresponding author: LUO Xinhua, luoxh09@163.com (ORCID: 0000-0002-0323-3868)

摘要

摘要: 肝硬化患者营养不良和衰弱是相互联系的多维度问题。营养不良是导致机体衰弱的原因之一，而衰弱是人体机能障碍的综合表现，二者相互作用并进一步影响肝硬化患者的临床转归。因此，应及早发现、准确评估并积极治疗营养不良和衰弱，以减少临床并发症、延长生存期及改善生活质量。在针对肝硬化病因及并发症治疗的基础上，加强营养管理和体育锻炼是治疗营养不良及机体衰弱的主要措施，而睾酮替代等药物治疗的临床效果尚需进一步研究。
- 肝硬化 /
- 营养不良 /
- 衰弱 /
- 临床管理
Abstract: Malnutrition and asthenia are interrelated and multidimensional problems in patients with liver cirrhosis. Malnutrition is one of the reasons leading to asthenia, whereas asthenia is a comprehensive manifestation of functional disorders, and malnutrition and asthenia interact with each other and further affect the clinical outcome of patients with liver cirrhosis. Therefore, early identification, accurate assessment, and active treatment of malnutrition and asthenia should be taken seriously to reduce clinical complications, prolong survival time, and improve quality of life. In addition to the therapies targeting the etiology and complications of liver cirrhosis, nutritional management and physical exercise are the main measures for the treatment of malnutrition and asthenia, and further studies are needed to explore the clinical efficacy of medical treatment such as testosterone replacement therapy.
- Liver Cirrhosis /
- Malnutrition /
- Frailty /
- Clinical Governance

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参考文献(38)

[1]	LOCHS H, ALLISON SP, MEIER R, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics[J]. Clin Nutr, 2006, 25(2): 180-186. DOI: 10.1016/j.clnu.2006.02.007.
[2]	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[J]. Hepatology, 2021, 74(3): 1611-1644. DOI: 10.1002/hep.32049.
[3]	MORLEY JE, VELLAS B, van KAN GA, et al. Frailty consensus: a call to action[J]. J Am Med Dir Assoc, 2013, 14(6): 392-397. DOI: 10.1016/j.jamda.2013.03.022.
[4]	TOSHIKUNI N, ARISAWA T, TSUTSUMI M. Nutrition and exercise in the management of liver cirrhosis[J]. World J Gastroenterol, 2014, 20(23): 7286-7297. DOI: 10.3748/wjg.v20.i23.7286.
[5]	BUNCHORNTAVAKUL C, REDDY KR. Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis[J]. Aliment Pharmacol Ther, 2020, 51(1): 64-77. DOI: 10.1111/apt.15571.
[6]	MERLI M, RIGGIO O, DALLY L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi)[J]. Hepatology, 1996, 23(5): 1041-1046. DOI: 10.1002/hep.510230516.
[7]	EBADI M, MONTANO-LOZA AJ. Sarcopenia and frailty in the prognosis of patients on the liver transplant waiting list[J]. Liver Transpl, 2019, 25(1): 7-9. DOI: 10.1002/lt.25386.
[8]	TANDON P, TANGRI N, THOMAS L, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis: A prospective evaluation of the clinical frailty scale[J]. Am J Gastroenterol, 2016, 111(12): 1759-1767. DOI: 10.1038/ajg.2016.303.
[9]	CRON DC, FRIEDMAN JF, WINDER GS, et al. Depression and frailty in patients with end-stage liver disease referred for transplant evaluation[J]. Am J Transplant, 2016, 16(6): 1805-1811. DOI: 10.1111/ajt.13639.
[10]	MEYER F, BANNERT K, WIESE M, et al. Molecular mechanism contributing to malnutrition and sarcopenia in patients with liver cirrhosis[J]. Int J Mol Sci, 2020, 21(15): 5357. DOI: 10.3390/ijms21155357.
[11]	TANDON P, RAMAN M, MOURTZAKIS M, et al. A practical approach to nutritional screening and assessment in cirrhosis[J]. Hepatology, 2017, 65(3): 1044-1057. DOI: 10.1002/hep.29003.
[12]	CHEUNG K, LEE SS, RAMAN M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies[J]. Clin Gastroenterol Hepatol, 2012, 10(2): 117-125. DOI: 10.1016/j.cgh.2011.08.016.
[13]	DUDRICK SJ, KAVIC SM. Hepatobiliary nutrition: history and future[J]. J Hepatobiliary Pancreat Surg, 2002, 9(4): 459-468. DOI: 10.1007/s005340200057.
[14]	TSIAOUSI ET, HATZITOLIOS AI, TRYGONIS SK, et al. Malnutrition in end stage liver disease: recommendations and nutritional support[J]. J Gastroenterol Hepatol, 2008, 23(4): 527-533. DOI: 10.1111/j.1440-1746.2008.05369.x.
[15]	HOLICK MF. Vitamin D deficiency[J]. N Engl J Med, 2007, 357(3): 266-281. DOI: 10.1056/NEJMra070553.
[16]	DOLZ C, RAURICH JM, IBÁÑEZ J, et al. Ascites increases the resting energy expenditure in liver cirrhosis[J]. Gastroenterology, 1991, 100(3): 738-744. DOI: 10.1016/0016-5085(91)80019-6.
[17]	AQEL BA, SCOLAPIO JS, DICKSON RC, et al. Contribution of ascites to impaired gastric function and nutritional intake in patients with cirrhosis and ascites[J]. Clin Gastroenterol Hepatol, 2005, 3(11): 1095-1100. DOI: 10.1016/s1542-3565(05)00531-8.
[18]	ARROYO V, GARCÍA-MARTINEZ R, SALVATELLA X. Human serum albumin, systemic inflammation, and cirrhosis[J]. J Hepatol, 2014, 61(2): 396-407. DOI: 10.1016/j.jhep.2014.04.012.
[19]	ALBILLOS A, LARIO M, ÁLVAREZ-MON M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance[J]. J Hepatol, 2014, 61(6): 1385-1396. DOI: 10.1016/j.jhep.2014.08.010.
[20]	LAI JC, FENG S, TERRAULT NA, et al. Frailty predicts waitlist mortality in liver transplant candidates[J]. Am J Transplant, 2014, 14(8): 1870-1879. DOI: 10.1111/ajt.12762.
[21]	WU MC, MENG QH. Nutritional assessment and clinical management of patients with acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(4): 770-774. DOI: 10.3969/j.issn.1001-5256.2021.04.006. 吴牧晨, 孟庆华. 慢加急性肝衰竭患者的营养评估及临床管理[J]. 临床肝胆病杂志, 2021, 37(4): 770-774. DOI: 10.3969/j.issn.1001-5256.2021.04.006.
[22]	ALBERINO F, GATTA A, AMODIO P, et al. Nutrition and survival in patients with liver cirrhosis[J]. Nutrition, 2001, 17(6): 445-450. DOI: 10.1016/s0899-9007(01)00521-4.
[23]	BHARADWAJ S, GINOYA S, TANDON P, et al. Malnutrition: laboratory markers vs nutritional assessment[J]. Gastroenterol Rep (Oxf), 2016, 4(4): 272-280. DOI: 10.1093/gastro/gow013.
[24]	FRANCOZ C, PRIÉ D, ABDELRAZEK W, et al. Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score[J]. Liver Transpl, 2010, 16(10): 1169-1177. DOI: 10.1002/lt.22128.
[25]	GAO W, KONG M, YAO J, et al. Changes in prealbumin and body mass index associated with T lymphocyte subsets and nutritional status in chronic hepatitis B and HBV-cirrhosis patients[J]. Clin Lab, 2018, 64(11). DOI: 10.7754/Clin.Lab.2018.180501.
[26]	ARORA S, MATTINA C, MCANENNY C, et al. The development and validation of a nutritional prioritising tool for use in patients with chronic liver disease[J]. J Hepatol, 2012, 56: S241. DOI: 10.1016/S0168-8278(12)60621-7.
[27]	SU MZ, WU YJ, LI L, et al. Comparison of the NRS-2002 and RFH-NPT in patients with cirrhosis: based on SGA criteria[J]. Chin J Clin Gastroenterol, 2022, 34(1): 1-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXH202201001.htm 苏蒙召, 吴远珏, 李玲, 等. NRS-2002与RFH-NPT在肝硬化患者中应用比较: 基于SGA标准[J]. 临床消化病杂志, 2022, 34(1): 1-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXH202201001.htm
[28]	BORHOFEN SM, GERNER C, LEHMANN J, et al. The Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis[J]. Dig Dis Sci, 2016, 61(6): 1735-1743. DOI: 10.1007/s10620-015-4015-z.
[29]	WU Y, ZHU Y, FENG Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002[J]. Br J Nutr, 2020, 124(12): 1293-1302. DOI: 10.1017/S0007114520002366.
[30]	BROWN CS, BIESTERVELD BE, MONTGOMERY JR, et al. Frailty is associated with increased rates of acute cellular rejection within 3 months after liver transplantation[J]. Liver Transpl, 2020, 26(4): 606-607. DOI: 10.1002/lt.25690.
[31]	TAPPER EB, KONERMAN M, MURPHY S, et al. Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index[J]. Am J Transplant, 2018, 18(10): 2566-2570. DOI: 10.1111/ajt.15020.
[32]	AMODIO P, BEMEUR C, BUTTERWORTH R, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J]. Hepatology, 2013, 58(1): 325-336. DOI: 10.1002/hep.26370.
[33]	GLUUD LL, DAM G, LES I, et al. Branched-chain amino acids for people with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2015, (9): CD001939. DOI: 10.1002/14651858.CD001939.pub3.
[34]	KUMAR A, DAVULURI G, SILVA R, et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis[J]. Hepatology, 2017, 65(6): 2045-2058. DOI: 10.1002/hep.29107.
[35]	BERZIGOTTI A, ALBILLOS A, VILLANUEVA C, et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study[J]. Hepatology, 2017, 65(4): 1293-1305. DOI: 10.1002/hep.28992.
[36]	SINCLAIR M, GROSSMANN M, HOERMANN R, et al. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: A randomised controlled trial[J]. J Hepatol, 2016, 65(5): 906-913. DOI: 10.1016/j.jhep.2016.06.007.
[37]	KOVACHEVA EL, HIKIM AP, SHEN R, et al. Testosterone supplementation reverses sarcopenia in aging through regulation of myostatin, c-Jun NH2-terminal kinase, Notch, and Akt signaling pathways[J]. Endocrinology, 2010, 151(2): 628-638. DOI: 10.1210/en.2009-1177.
[38]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024.