基于营养风险评估的多学科协同个体化营养干预对肝硬化患者营养状况、肝功能及血清肝纤维化指标的短期影响

Short-term effects of multidisciplinary collaborative individualized nutritional intervention based on nutritional risk assessment on nutritional status, liver function, and serum liver fibrosis markers in patients with cirrhosis

摘要

目的：评价基于营养风险评估的多学科协同（multi-disciplinary team，MDT）个体化营养干预对肝硬化患者短期（3个月）营养状况、肝功能及血清肝纤维化指标的影响。方法：选取2023年5月—2025年5月扬州大学附属高邮市人民医院收治的60例肝硬化患者，采用随机数表法将患者分为对照组（常规营养管理，n=30）和干预组（常规营养管理联合基于营养风险评估的MDT营养干预，n=30）。两组患者均在入院第1天接受相应营养干预，为降低入院初期液体波动与急性应激对实验室指标的影响，将入院第2天晨间抽血与体格测量作为基线（T0），并于出院后1个月（T1）和3个月（T2）随访。观察指标包括营养状况[体质指数（body mass index，BMI）、血红蛋白（hemoglobin，Hb）、血清白蛋白（serum albumin，ALB）、前白蛋白（prealbumin，PA）]、肝功能[丙氨酸氨基转移酶（alanine aminotransferase，ALT）、凝血酶原时间（prothrombin time，PT）、总蛋白（total protein，TP）]及血清肝纤维化指标[Ⅳ型㬵原（collagen Ⅳ，Ⅳ-C）、透明质酸（hyaluronic acid，HA）、层黏连蛋白（laminin，LN）、Ⅲ型前㬵原（procollagen Ⅲ，PCⅢ）]。采用混合线性模型分析不同时间点两组间各指标的差异及变化趋势。结果：干预组BMI、Hb、ALB、TP水平均高于对照组（P<0.05）；ALT、PT、Ⅳ-C、HA、LN、PCⅢ水平均低于对照组（P<0.05）。混合线性模型分析显示，干预组各项指标随时间变化的改善速度明显快于对照组，但不同指标的反应幅度并不完全一致，TP、ALB、ALT、PT、Ⅳ-C、HA、LN、PCⅢ等指标的组别与时间的交互效应显著（P<0.05）。结论：基于营养风险评估的MDT营养干预能有效改善肝硬化患者的短期营养状况和肝功能，降低血清肝纤维化标志物水平，但研究随访较短，暂不能推断远期临床结局。

Abstract

Objective: To evaluate the impact of individualized nutritional intervention by a multidisciplinary team (MDT) based on nutritional risk assessment on short-term (3 months) nutritional status, liver function, and serum liver fibrosis markers in patients with cirrhosis. Methods: A total of 60 patients with cirrhosis admitted to the People’s Hospital of Gaoyou Affiliated to Yangzhou University from May 2023 to May 2025 were selected and divided into a control group (conventional nutritional management, n=30) and an intervention group (conventional nutritional management combined with MDT nutritional intervention based on nutritional risk assessment, n=30) using a random number table. Both groups of patients received appropriate nutritional intervention on day 1 of admission. To reduce the impact of fluid fluctuations and acute stress on laboratory indicators in the early stages of admission, blood samples taken in the morning of day 2 of admission and physical measurements were used as the baseline (T0). Follow-up was conducted at 1 month (T1) and 3 months (T2) after discharge. The observed indicators included nutritional status [body mass index (BMI), hemoglobin (Hb), serum albumin (ALB), prealbumin (PA)], liver function [alanine aminotransferase (ALT), prothrombin time (PT), total protein (TP)] and liver fibrosis indicators [collagen Ⅳ (Ⅳ-C), hyaluronic acid (HA), laminin (LN), prothrombin Ⅲ (PCⅢ)] were evaluated on the second day, one month and three months after admission. Mixed linear models were used to analyze the differences and changing trends of each indicator between the two groups at different time points. Results: The examination results of the patients showed that the levels of BMI, Hb, ALB and TP in the intervention group were higher than those in the control group (P<0.05); the levels of ALT, PT, Ⅳ-C, HA, LN and PCⅢ were lower than those in the control group (P<0.05). Mixed linear model analysis showed that the intervention group improved significantly faster than the control group over time in terms of various indicators, but the response magnitudes of different indicators were not completely consistent. The interaction effects between groups and time were significant for TP, ALB, ALT, PT, Ⅳ-C, HA, LN, and PCⅢ (P<0.05). Conclusion: Nutritional intervention based on nutritional risk assessment by MDT can effectively improve the short-term nutritional status, liver function, and serum liver fibrosis markers in patients with cirrhosis. However, the follow-up period of the study was short, and long-term clinical outcomes cannot be inferred at this time.

关键词

肝硬化 / 营养风险评估 / 多学科协同 / 营养干预 / 混合线性模型

Key words

liver cirrhosis / nutrition risk assessment / multidisciplinary team / nutrition intervention / mixed linear model

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基金资助

扬州市卫生健康委员会科研项目(2023416)