Abstract:

Objective　To investigate the effects of dietary support at night on liver reserve function, anthropometric indicators, and protein levels in patients with chronic acute liver failure treated by transjugular intrahepatic portal vein shunt (TIPS). Methods　A total of 107 patients with chronic acute liver failure who received TIPS in First Hospital, Henan University of Science and Technology from September 2020 to September 2022 were selected for the prospective study, and were divided into a control group (53 cases) and a study group (54 cases) by the simple randomization method. There were 42 males and 11 females in the control group; they were 27-69 (53.15±4.79) years old. There were 45 males and 9 females in the study group; they were 24-67 (52.48±5.02) years old. The control group received daily dietary support treatment; in addition, the study group took night meal nutritional support. Both groups were treated for 2 months. t test was used. Results　The scores of the nutrition risk screening (NRS-2002) and Child-Pugh 1 month after the treatment in the study group were lower than those in the control group [(2.43±0.47) vs. (3.68±0.91) and (7.12±1.41) vs. (8.64±1.63)], with statistical differences (t=8.90 and 5.16; both P<0.05). One month after the treatment, the body mass index (BMI), upper arm muscle circumference (MAMC), and triceps skin fold thickness (TSF) in the study group were higher than those in the control group [(22.11±1.83) kg/m² vs. (21.09±2.05) kg/m², (24.18±2.35) cm vs. (22.48±3.02) cm, and (13.06±3.31) cm vs. (11.26±2.78) cm], with statistical differences (t=2.71, 3.25, and 3.05; all P<0.05). One month after the treatment, the levels of albumin (ALB), prealbumin (PA), and transferrin (TRF) in the study group were higher than those in the control group [(34.06±7.24) g/L vs. (31.26±6.71) g/L, (138.26±33.49) mg/L vs. (103.18±24.36) mg/L, and (1 887.14±241.59) mg/L vs. (1 695.26±216.31) mg/L], with statistical differences (t=2.08, 6.21, and 4.33; all P<0.05). Conclusion　Adding nutritional support therapy with night meal can reduce the risk of malnutrition in patients with chronic acute liver failure after TIPS, enhance their liver reserve function, and improve their physical and nutritional status.

Key words:

Chronic plus acute liver failure, Transjugular intrahepatic portal vein shunt, Nutritional support with extra meals at night, Liver reserve function, Nutritional risk

摘要：

目的　探讨夜间加餐营养支持对慢加急性肝衰竭患者经颈静脉肝内门体静脉分流术（TIPS）治疗后的肝脏储备功能、人体测量学指标及蛋白水平影响。方法　前瞻性研究，选取2020年9月至2022年9月来河南科技大学第一附属医院接受治疗的107例经TIPS治疗后的慢加急性肝衰竭患者作为研究对象，根据简单随机化法将其分为对照组（53例）与研究组（54例）。对照组：男42例，女11例，年龄27～69（53.15±4.79）岁，接受日间加餐营养支持治疗；研究组：男45例，女9例，年龄24～67（52.48±5.02）岁，在对照组的基础上增加夜间加餐营养支持治疗。治疗时间均为1个月，统计学方法采用t检验。结果　治疗1个月后，研究组的营养风险筛查（NRS-2002）评分低于对照组［（2.43±0.47）分比（3.68±0.91）分］，差异有统计学意义（t=8.90，P<0.05）。治疗1个月后，研究组的Child-Pugh评分低于对照组［（7.12±1.41）分比（8.64±1.63）分］，差异有统计学意义（t=5.16，P<0.05）。治疗1个月后，研究组体质量指数（BMI）、上臂肌围（MAMC）、肱三头肌皮褶厚度（TSF）水平均高于对照组［（22.11±1.83）kg/m²比（21.09±2.05）kg/m²、（24.18±2.35）cm比（22.48±3.02）cm、（13.06±3.31）cm比（11.26±2.78）cm］，差异均有统计学意义（t=2.71、3.25、3.05，均P<0.05）。治疗1个月后，研究组白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TRF）水平均高于对照组［（34.06±7.24）g/L比（31.26±6.71）g/L、（138.26±33.49）mg/L比（103.18±24.36）mg/L、（1 887.14±241.59）mg/L比（1 695.26±216.31）mg/L］，差异均有统计学意义（t=2.08、6.21、4.33，均P<0.05）。结论　增加夜间加餐营养支持治疗可以降低慢加急性肝衰竭患者经TIPS治疗后的营养不良发生风险，增强肝脏储备功能，改善患者的身体状况及营养状态。

关键词:

慢加急性肝衰竭, 经颈静脉肝内门体静脉分流术, 夜间加餐营养支持, 肝脏储备功能, 营养风险