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    肝硬化合并轻微型肝性脑病病人的临床营养状况评估及相关性因素分析

    Evaluation of clinical nutritional status and correlation factors in patients with cirrhosis complicated with minimal hepatic encephalopathy

      摘要
    • 摘要:
      目的 评估肝硬化合并轻微型肝性脑病(MHE)病人的临床营养不良状况的发生情况，并分析肝硬化病人发生MHE的预测因素。
      方法 收集确诊为肝硬化的住院病人相关资料，对其进行优势手握力、数字连接试验(NCT)-A、数字符号试验(DST)及动物命名试验(ANT)测试，根据测试结果有无合并肝性脑病分为MHE组和N-MHE组，记录其测试结果并收集临床数据，分别测量中腹部CT平扫图像中右侧第三腰椎椎体(L3)中心层面以及脐水平平面腰大肌厚度(TPMT)，然后与身高进行比值(TPMT/H)，评价TPMT/H对营养不良及MHE的诊断价值，并建立其最佳临界值。
      结果 共纳入114例肝硬化病人，MHE患病率为28.07%(32/114)。MHE组优势手握力和TPMT/H比值低于N-MHE组(P < 0.01)，2组L3平面、脐平面的TPMT/H比较差异均有统计学意义(P < 0.01)。二元logistic回归分析证实，血氨、右侧脐平面TPMT/H是病人住院期间发生MHE的独立危险因素(P < 0.05)。ROC曲线分析血氨曲线下面积较TPMT/H明显偏低，脐平面TPMT/H与优势手握力呈强相关(r=0.629，P < 0.01)，L3平面TPMT/H与优势手握力呈中等相关(r=0.541，P < 0.01)。
      结论 肌肉减少与肝硬化病人MHE的发生密切相关，通过测量TPMT/H(右侧脐水平平面)有助于预测肝硬化病人MHE的发生。

       

      Abstract:
      Objective To evaluate the incidence of clinical malnutrition in patients with cirrhosis combined with minimal hepatic encephalopathy (MHE) and analyze the predictive factors for the occurrence of MHE in cirrhosis patients.
      Methods Relevant data of hospitalized patients diagnosed with cirrhosis was collected. Dominant grip strength, number connectivity test (NCT)-A, number symbol test (DST), and animal naming test (ANT) tests on them were conducted. According to the test results, they were divided into MHE group and N-MHE group based on the presence or absence of hepatic encephalopathy. The test results were recorded and clinical data was collected. The psoas major muscle thickness (TPMT) at the central plane of the right third lumbar vertebral body (L3) and the umbilical horizontal plane in the mid-abdominal CT plain scan images were measured, and then compared with height (TPMT/H) to evaluate the diagnostic value of TPMT/H for malnutrition and MHE, and its optimal critical value was established.
      Results A total of 114 patients with cirrhosis were included, and the incidence of MHE was 28.07% (32/114). The dominant grip strength and TPMT/H ratio in the MHE group were lower than those in the N-MHE group (P < 0.01), and there were statistically significant differences in TPMT/H between the L3 and umbilical planes between the two groups (P < 0.01). Binary logistic regression analysis confirmed that plasma ammonia and right umbilical plane TPMT/H were independent risk factors for MHE during hospitalization (P < 0.05). ROC curve analysis showed that the area under the plasma ammonia curve was significantly lower than that of TPMT/H. The umbilical plane TPMT/H was strongly correlated with dominant hand grip strength (r=0.629, P < 0.01), while the L3 plane TPMT/H was moderately correlated with dominant hand grip strength (r=0.541, P < 0.01).
      Conclusions Muscle loss is closely related to the occurrence of MHE in cirrhosis patients, and measuring TPMT/H (right umbilical horizontal plane) can help predict the occurrence of MHE in cirrhosis patients.

       

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