握力测量法在肝硬化病人营养状态评估中的临床应用

康颖; 祁平平; 曹琳琳; 杨欣

doi:10.13898/j.cnki.issn.1000-2200.2020.10.015

握力测量法在肝硬化病人营养状态评估中的临床应用

Clinical application value of grip strength measurement in the assessment of nutritional status of patients with cirrhosis

摘要

摘要:
目的探讨握力（GS）测量法在肝硬化病人营养状态评估中的应用价值。
方法选择住院治疗的肝硬化病人76例，采用微型营养表（MNA-SF）评估肝硬化病人的营养状况，并根据MNA-SF评分将病人分为营养正常组（n=21）、营养不良风险组（n=30）、营养不良组（n=25），分别测量3组病人的人体测量指标、人体成分指标、生化指标以及静息能量消耗，并与GS进行相关性分析。
结果营养正常组病人的GS、上臂围（MAC）、上臂肌围（AMC）、小腿围（CC）、肱三头肌皮褶厚度（TSF）、体质量指数（BMI）均显著高于营养不良风险组、营养不良组（P < 0.01）；营养不良风险组病人的GS、MAC、AMC、CC、TSF、BMI均显著高于营养不良组（P < 0.01）。3组病人的细胞内液（ICW）、细胞外液（ECW）、身体总水（TBW）比较差异无统计学意义（P>0.05）；营养正常病人病人的浮肿指数（ECW/TBW）显著低于营养不良风险组、营养不良组（P < 0.01）；营养不良风险组病人的ECW/TBW显著低于营养不良组（P < 0.01）。营养不良风险组、营养不良组病人的静息能量消耗实测值（REE Prre）明显高于静息能量消耗预测值（REE Meal）（P < 0.01）；营养不良风险组、营养不良组病人的REE Prre明显高于营养正常组（P < 0.01）；营养不良组病人的REE Prre明显高于营养不良风险组（P < 0.01）。营养正常组病人的视黄醇结合蛋白（RBP）、血清白蛋白（ALB）、血红蛋白（Hb）、纤维连接蛋白（FN）、转铁蛋白（TRF）、前白蛋白（PA）、总淋巴细胞计数（TLC）水平明显高于营养不良风险组、营养不良组（P < 0.01）；营养不良风险组病人的TRF、ALB、Hb、FN、RBP、PA、TLC水平明显见高于营养不良组（P < 0.01）。Pearson相关性分析显示，握力与MAC、AMC、CC、BMI、ALB呈显著正相关（P < 0.01）；握力与TSF、REE Prre呈显著负相关关系（P < 0.01）；握力与TRF、PA、Hb、FN、RBP、TLC无相关性（P>0.05）。
结论握力与肝硬化病人的其他营养性指标具有密切相关性，故握力测量法可作为肝硬化病人营养状态评估方法，在临床中进一步推广使用。

Abstract:
ObjectiveTo explore the application value of grip strength(GS) measurement in the assessment of nutritional status of patients with cirrhosis.
MethodsThe nutritional status of 76 patients with cirrhosis were assessed using MNA-SF.According to the MNA-SF score, the patients were divided into the normal nutrition group(n=21), malnutrition risk group(n=30) and malnutrition group(n=25).The anthropometric index, human component index, biochemical index and resting energy consumption in three groups were measured, and their correlation with GS were analyzed.
ResultsThe GS, MAC, AMC, CC, TSF and BMI in normal nutrition group were significantly higher than those in malnutrition risk group and malnutrition group(P < 0.01);and the GS, MAC, AMC, CC, TSF and BMI in malnutrition risk group were significantly higher than those in malnutrition group(P < 0.01).There was no statistical significance in the ICW, ECW and TBW among three groups(P>0.05).The ECW/TBW in normal nutrition group was significantly lower than that in malnutrition risk group and malnutrition group(P < 0.05), and the ECW/TBW in malnutrition risk group was significantly lower than that in malnutrition group(P < 0.01).In malnutrition risk group and malnutrition group, the REE Prre were significantly higher than REE Meal(P < 0.01), the REE Prre in malnutrition risk group and malnutrition group were significantly higher than that in normal group(P < 0.01), and the REE Prre in malnutrition group was significantly higher than that in malnutrition risk group(P < 0.01).The results of Pearson correlation analysis showed that GS was positively correlated with MAC, AMC, CC, BMI and ALB(P < 0.01), negatively correlated with TSF and REE Prre(P < 0.01), and not correlated with TRF, PA, Hb, FN, RBP and TLC(P>0.05).
ConclusionsGS is closely related to other nutritional indicators in patients with cirrhosis.Therefore, GS measurement can be used as a nutritional status assessment method in patients with cirrhosis, and it can be further popularized in clinical practice.

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