摘要
目的 对失代偿期肝硬化患者进行营养评估,对其影响因素进行分析,探索抑郁情绪倾向与肝硬化营养不良的相关性及其危险因素.方法 选择山西医科大学第一医院消化内科2023年6至9月入院的190例肝硬化患者,收集其临床资料,对符合纳排标准的患者以主观全面评定表评估患者营养状况等级,以流调中心抑郁量表为工具,评估患者抑郁情绪倾向,并收集相关临床数据进行分析.结果 185例患者符合纳入标准,分为无营养不良组(126例)和营养不良组(59例).两组流调中心抑郁量表得分、年龄、体重指数、血小板、D-二聚体、血清钠、第三腰椎骨骼肌指数、握力、三头肌皮褶厚度、上臂肌围比较差异有统计学意义(P＜0.05).握力、三头肌皮褶厚度、上臂肌围、血清钠、有抑郁情绪倾向与肝硬化营养不良的发生具有相关性(P＜0.05).5项指标联合诊断肝硬化营养不良的曲线下面积可达81.9％.结论 抑郁情绪与肝硬化营养不良的发生密切相关,血清钠≤135 mmol/L、握力、三头肌皮褶厚度、上臂肌围未达到正常值、有抑郁情绪倾向是肝硬化营养不良的独立危险因素,5项指标联合诊断可提高肝硬化营养不良的诊断率.
Abstract
Objective To evaluate the nutritional status of patients with decompensated liver cirrhosis and explore the correlation with malnutrition and the risk factors of depressed mood.Methods 190 cirrhotic patients admitted to the Department of Gastroenterology of the First Hospital of Shanxi Medical University from June to September 2023 were selected according to the inclusion and exclusion criteria.Eligible patients were divided into subgroups based on the presence or absence of malnutrition as determined by subjective global assessment(SGA).The Center for Epidemiological Studies Depression(CES-D)scale was used to assess patients'propensity for depressed mood.Relevant clinical data were also collected and analyzed.Results A total of 185 patients were included,of which 126 were in the non-malnutrition group and 59 malnutrition group.There were significant between-group differences in terms of CES-D results,age,body mass index,platelets,D-dimer,serum sodium,third lumbar skeletal muscle index,grip strength,triceps skinfold thickness,and upper arm muscle circumference(all P＜0.05).Correlation analysis showed that grip strength,triceps skinfold thickness,upper arm muscle circumference,serum sodium,and depressed mood tendency status were correlated with the development of cirrhotic malnutrition(P＜0.05).The diagnostic model for malnutrition in cirrhosis using these five indicators showed the area under the curve of 81.9％.Conclusions Depression is closely related to the development of malnutrition in patients with liver cirrhosis.Independent risk factors for malnutrition in cirrhosis include serum sodium≤135 mmol/L,grip strength,triceps skinfold thickness,lower-than-normal upper arm circumference,and the tendency of depression,which demonstrate the combined contribution to the diagnosis of malnutrition in cirrhosis.
基金项目
山西省基础研究计划自然科学研究面上项目(20210302123246)
山西省卫生健康科研课题(2020)(2020079)
NETL
NSTL
万方数据