相位角与肝硬化病人营养状况及临床结局的关系研究
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摘要
目的:观察用生物电阻抗法测得的相位角(PA)与肝硬化病人营养状况的关系,探讨其对临床结局的影响。方法:收集肝硬化住院病人145例,进行营养风险筛查、人体测量、血生化检查、人体成分分析,根据PA将病人分为低PA组和正常PA组,分析PA与营养相关指标的关系;随访48个月,比较两组存活、并发症发生情况。结果:55.9%(81/145)肝硬化病人PA低于正常。低PA组年龄大于正常PA组,血清总蛋白(TP)、白蛋白(ALB)和胆碱酯酶(CHE)、血红蛋白(HB)、上臂肌围(AMC)、握力(GS)、身体细胞量(BCM)、去脂体重(FFM)低于正常PA组(P <0.05),浮肿指数(ECW/TBW)高于后者(P <0.05),而前白蛋白(PALB)、脂肪含量(FM)等指标两组无明显差异(P> 0.05)。PA与年龄、ECW/TBW呈负相关(P <0.05),与TP、ALB、CHE、PALB、HB、AMC、GS、BCM、FFM呈正相关(P <0.05)。低PA与营养风险、肝功能恶化,腹/胸水、食管/胃底静脉曲张、肝性脑病明显相关(P <0.05);随着肝功能进展,PA值呈下降趋势(P <0.05)。随访期间低PA组死亡率和感染发生率高于正常PA组(P<0.05),低PA组死亡、感染风险分别升高2.371倍[OR=3.371,95%CI(1.177, 9.659)]和2.369倍[OR=3.369,95%CI(1.169,11.666)]。结论:PA可反映肝硬化病人的营养状况,低PA与年龄、肝功能、并发症有关,低PA者死亡、发生并发症的风险升高。相位角的检测有助于肝硬化病人的营养状况评估及临床结局预测。
Objective: To observe the association of bioelectrical impedance phase angle(PA) and nutritional status in liver cirrhosis patients, and to explore the effect on clinical outcomes. Methods: 145 inpatients with liver cirrhosis were collected for nutritional risk screening, anthropometry, biochemical examination and body composition analysis.The patients were divided into low PA group and normal PA group. To evaluate the association of PA with the nutritional status. The survival and complications of the two groups were compared after 48 months of follow-up.Results: 55.9%(81/145) of cirrhotic patients had lower PA. The age of low PA group was older than that of normal PA group. Total serum protein(TP), albumin(ALB), cholinesterase(CHE), hemoglobin(HB), upper arm muscle circumference(AMC), grip strength(GS), body cell mass(BCM), fat-free weight(FFM) were lower than that of normal PA group(P < 0.05). Edema index(ECW/TBW) was higher than that of normal PA group(P < 0.05). While there were no significant difference in prealbumin(PALB) and fat mass(FM) between two groups(P > 0.05). PA was negatively correlated with age and ECW/TBW(P < 0.05), but positively correlated with TP, ALB, CHE, PALB, HB, AMC, GS,BCM and FFM(P < 0.05). Low PA was significantly associated with nutritional risk, deterioration of liver function,abdominal/pleural effusion, esophageal/gastric varices and encephalopathy(P < 0.05). PA reduced gradually with the progress of liver function(P < 0.05). During the follow-up period, the mortality and infection rate in the low PA group were higher than those in the normal PA group(P < 0.05). The risk of death and infection in the low PA group increased by 2.371 times(OR = 3.371, 95% CI [1.177, 9.659]) and 2.369 times(OR = 3.369, 95% CI [1.169, 11.666]).Conclusions: PA can reflect the nutritional status of patients with liver cirrhosis. Low PA is association with older age,liver dysfunction and complications, which increases the risk of death and complications. PA measurement is conducive to assessing nutritional status and predicting clinical outcome in patients with cirrhosis.
Objective: To observe the association of bioelectrical impedance phase angle(PA) and nutritional status in liver cirrhosis patients, and to explore the effect on clinical outcomes. Methods: 145 inpatients with liver cirrhosis were collected for nutritional risk screening, anthropometry, biochemical examination and body composition analysis.The patients were divided into low PA group and normal PA group. To evaluate the association of PA with the nutritional status. The survival and complications of the two groups were compared after 48 months of follow-up.Results: 55.9%(81/145) of cirrhotic patients had lower PA. The age of low PA group was older than that of normal PA group. Total serum protein(TP), albumin(ALB), cholinesterase(CHE), hemoglobin(HB), upper arm muscle circumference(AMC), grip strength(GS), body cell mass(BCM), fat-free weight(FFM) were lower than that of normal PA group(P < 0.05). Edema index(ECW/TBW) was higher than that of normal PA group(P < 0.05). While there were no significant difference in prealbumin(PALB) and fat mass(FM) between two groups(P > 0.05). PA was negatively correlated with age and ECW/TBW(P < 0.05), but positively correlated with TP, ALB, CHE, PALB, HB, AMC, GS,BCM and FFM(P < 0.05). Low PA was significantly associated with nutritional risk, deterioration of liver function,abdominal/pleural effusion, esophageal/gastric varices and encephalopathy(P < 0.05). PA reduced gradually with the progress of liver function(P < 0.05). During the follow-up period, the mortality and infection rate in the low PA group were higher than those in the normal PA group(P < 0.05). The risk of death and infection in the low PA group increased by 2.371 times(OR = 3.371, 95% CI [1.177, 9.659]) and 2.369 times(OR = 3.369, 95% CI [1.169, 11.666]).Conclusions: PA can reflect the nutritional status of patients with liver cirrhosis. Low PA is association with older age,liver dysfunction and complications, which increases the risk of death and complications. PA measurement is conducive to assessing nutritional status and predicting clinical outcome in patients with cirrhosis.
引文
[1]Huisman EJ, Trip EJ, Siersema PD, et al. Protein energy malnutrition predicts complications in liver cirrhosis. Eur J Gastroen Hepat, 2011, 23(11):982-989.
[2]Sam J, Nguyen GC. Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int, 2009, 136(5):1396-1402.
[3]Pirlich M, Schütz T, Spachos T, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology, 2010, 32(6):1208-1215.
[4]Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr, 2013, 32(2):294-299.
[5]Varan HD, Bolayir B, Kara O, et al. Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients. Aging Clin Exp Res, 2016, 28(6):1121-1126.
[6]Zouridakis A, Simos YV, Verginadis II, et al. Correlation of bioelectrical impedance analysis phase angle with changes in oxidative stress on end-stage renal disease patients, before,during, and after dialysis. Ren Fail, 2016, 38(5):738-743.
[7]Belarmino G, Gonzalez MC, Torrinhas RS, et al. Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis. World J Hepatol,2017, 9(7):401-408.
[8]Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4):415-421.
[9]Stob?us N, Pirlich M, Valentini L, et al. Determinants of bioelectrical phase angle in disease. Br J Nutr, 2012, 107(8):1217-1220.
[10]Stegel P, Kozjek NR, Brumen BA, et al. Bioelectrical impedance phase angle as indicator and predictor of cachexia in head and neck cancer patients treated with(chemo)radiotherapy. Eur J Clin Nutr, 2016, 70(5):602-606.
[11]吴圣楠,齐玉梅,陈亚军,等.多频生物电阻抗对肝硬化患者细胞内外液的探讨.世界华人消化杂志,2013,21(36):4170-4174.
[12]宁华英,赵崇法,齐玉梅.相位角预测手术病人营养风险及住院时间.肠外与肠内营养,2017,24(5):296-300.
[13]Kalaitzakis E. Gastrointestinal dysfunction in liver cirrhosis.World J Gastroenterol, 2014, 20(40):14686-14695.
[14]Abad S, Sotomayor G, Vega A, et al. The phase angle of electrical impedance is a predictor of long-term survival in dialysis patients. Nefrologia, 2011, 31(6):670-676.
[15]Peres WA, Lento DF, Baluz K, et al. Phase angle as a nutritional evaluation tool in all stages of chronic liver disease. Nutr Hosp,2012, 27(6):2072-2078.
[16]Schwenk A, Beisenherz A, R?mer K, et al. Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nutr, 2000, 72(2):496-501.
[2]Sam J, Nguyen GC. Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int, 2009, 136(5):1396-1402.
[3]Pirlich M, Schütz T, Spachos T, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology, 2010, 32(6):1208-1215.
[4]Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr, 2013, 32(2):294-299.
[5]Varan HD, Bolayir B, Kara O, et al. Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients. Aging Clin Exp Res, 2016, 28(6):1121-1126.
[6]Zouridakis A, Simos YV, Verginadis II, et al. Correlation of bioelectrical impedance analysis phase angle with changes in oxidative stress on end-stage renal disease patients, before,during, and after dialysis. Ren Fail, 2016, 38(5):738-743.
[7]Belarmino G, Gonzalez MC, Torrinhas RS, et al. Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis. World J Hepatol,2017, 9(7):401-408.
[8]Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4):415-421.
[9]Stob?us N, Pirlich M, Valentini L, et al. Determinants of bioelectrical phase angle in disease. Br J Nutr, 2012, 107(8):1217-1220.
[10]Stegel P, Kozjek NR, Brumen BA, et al. Bioelectrical impedance phase angle as indicator and predictor of cachexia in head and neck cancer patients treated with(chemo)radiotherapy. Eur J Clin Nutr, 2016, 70(5):602-606.
[11]吴圣楠,齐玉梅,陈亚军,等.多频生物电阻抗对肝硬化患者细胞内外液的探讨.世界华人消化杂志,2013,21(36):4170-4174.
[12]宁华英,赵崇法,齐玉梅.相位角预测手术病人营养风险及住院时间.肠外与肠内营养,2017,24(5):296-300.
[13]Kalaitzakis E. Gastrointestinal dysfunction in liver cirrhosis.World J Gastroenterol, 2014, 20(40):14686-14695.
[14]Abad S, Sotomayor G, Vega A, et al. The phase angle of electrical impedance is a predictor of long-term survival in dialysis patients. Nefrologia, 2011, 31(6):670-676.
[15]Peres WA, Lento DF, Baluz K, et al. Phase angle as a nutritional evaluation tool in all stages of chronic liver disease. Nutr Hosp,2012, 27(6):2072-2078.
[16]Schwenk A, Beisenherz A, R?mer K, et al. Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nutr, 2000, 72(2):496-501.