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摘要：
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摘要：目的 调查重症酒精性肝病（severe alcoholic liver disease，SALD）患者营养风险发生率，
为临床预防及治疗提供参考。方法 采用横断面研究，对2016年1月至2018年6月解放军总医院第五
医学中心收治的SALD患者进行营养风险筛查（NRS2002），根据NRS2002评分，将患者分为有营
养风险组（总分≥ 3分）和无营养风险组（总分＜ 3分）。记录患者身高和体质量，计算体重指数
（body mass index，BMI），同时检测患者血清总胆红素（total bilirubin，TBil）、丙氨酸氨基转移
酶（alanine aminotransfease，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、
前白蛋白（prealbumin，PA）、白蛋白（albumin，ALB）、凝血酶原活动度（prothrombin activity，
PTA）、钠（Na）、钾（K）、钙（Ca）、铁（Fe）、镁（Mg）、维生素B 12 及叶酸水平，计算
MELD评分，比较两组患者上述指标及腹膜炎、腹水、肝性脑病、食管胃底静脉曲张等并发症发生
率的差异。对患者进行Child-Turcotte-Pugh（CTP）评分，比较不同CTP分级患者营养风险发生率。
采用Log Rank（Mantel-Cox）比较患者生存率的差异。结果 本研究共纳入156例SALD患者，其中有
营养风险组113例，无营养风险组43例，营养风险发生率为72.44%。29例CTP A级患者中有营养风险者
5例（17.24%）；74例CTP B级患者中有营养风险者59例（79.73%）；53例CTP C级患者中有营养风险者49
例（92.45%）。有营养风险组和无营养风险组患者每日饮酒折合乙醇量（中位数：200.00 g vs 160.00 g）、
住院时间 [（17.53 ± 9.43）d vs（11.05 ± 5.96）d]、BMI [（23.76 ± 3.32）kg/m 2 vs（25.43 ± 3.71）kg/m 2 ]、MELD评分
（中位数：7.98分 vs 3.03分）、TBil（中位数：97.30 μmol/L vs 24.70 μmol/L）、ALP（中位数：142.00 U/L vs
111.00 U/L）、ALT（中位数：29.00 U/L vs 37.00 U/L）、AST（中位数：54.00 U/L vs 51.00 U/L）、
PA [（58.12 ± 33.60）mg/L vs （147.09 ± 75.72）mg/L]、ALB [（26.80 ± 4.10）g/L vs（35.80 ± 3.69）g/L]、PTA（中
位数：45.10% vs 74.20%）、Na [（136.79 ± 4.36）mmol/L vs（139.28 ± 2.74）mmol/L]、Ca [（2.09 ±
0.13）mmol/L vs（2.26 ± 0.19）mmol/L]、Mg [（0.74 ± 0.11）mmol/L vs（0.78 ± 0.09）mmol/L]、维生素B 12 （中
位数：860.20 pmol/L vs 560.31 pmol/L）、腹水发生率（79.65% vs 27.91%）和腹膜炎发生率（21.24%
vs 0.00%）的差异有统计学意义（P均＜ 0.05），年龄[（50.81 ± 9.60）岁 vs（49.42 ± 11.51）岁]、酒龄
[（22.80 ± 9.37）年 vs（21.42 ± 10.42）年]、K（中位数：3.70 mmol/L vs 3.80 mmol/L）、Fe [（20.07 ±
9.41）μmol/L vs （22.50 ± 10.88）μmol/L]、叶酸（中位数：16.21 nmol/L vs 16.37 nmol/L）、肝性脑病
发生率（9.73% vs 4.65%）及食管胃底静脉曲张发生率（3.54% vs 0.00%）的差异无统计学意义（P均＞
0.05）。在360 d随访中，有营养风险组病死41例，无风险组病死6例，两组累积生存率的差异有统计学
意义（χ 2 = 6.718，P = 0.0095）。结论 经NRS2002评估，SALD患者存在较高的营养风险，需进行营养
支持治疗。
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Abstract: Objective To investigate the incidence of nutritional risks of patients with severe alcoholic liver
disease (SALD) and to provide reference for clinical prevention and treatment. Methods Patients with
SALD in the Fifth Medical Center of PLA General Hospital from January 2016 to June 2018 were screened
for nutritional risk (NRS2002) in this cross-sectional study. According to NRS2002 score, the patients were
divided into nutrition risk group (total score ≥ 3) and non-nutrition risk group (total score ＜ 3). The height
and body mass of the patients was recorded, and body mass index (BMI) was calculated. Total bilirubin
(TBil), alanine aminotransfease (ALT), aspartate aminotransferase (AST), prealbumin (PA), albumin (ALB),
prothrombin activity (PTA), Na, K, Ca, Fe, Mg, vitamin B 12 and folic acid levels were detected and the MELD
scores were calculated. The difference of the above indexes and the incidence of complications including
ascites, peritonitis, hepatic encephalopathy and esophageal and gastric fundus varices were compared between
the two groups. Child-Turcotte-Pugh (CTP) scores were performed to compare the incidence of nutritional
risk in patients with different CTP grades. Log Rank (Mantel-Cox) was used to compare the differences in the
survival rate of the patients. Results Total of 156 patients with SALD were enrolled, including 113 cases in
nutrition risk group and 43 cases in non-nutrition risk group, the incidence of nutrition risk was 72.44%. There
were 5 cases with nutritional risk out of the 29 cases with CTP A grade (17.24%), 59 cases with nutritional
risk out of the 74 cases with CTP B grade (79.73%) and 49 cases with nutritional risk out of the 53 cases with CTP
C grade (92.45%). Daily ethanol intake (median: 200.00 g vs 160.00 g), length of hospital stay [(17.53 ± 9.43) d vs
(11.05 ± 5.96) d], BMI [(23.76 ± 3.32) kg/m 2 vs (25.43 ± 3.71) kg/m 2 ], MELD score (median: 7.98 vs
3.03), TBil (median: 97.30 μmol/L vs 24.70 μmol/L), ALP (median: 142.00 U/L vs 111.00 U/L), ALT (median:
29.00 U/L vs 37.00 U/L), AST (median: 54.00 U/L vs 51.00 U/L), PA [(58.12 ± 33.60) mg/L vs (147.09 ±
75.72) mg/L], ALB [(26.80 ± 4.10) g/L vs (35.80 ± 3.69) g/L], PTA (median: 45.10% vs 74.20%), Na [(136.79 ±
4.36) mmol/L vs (139.28 ± 2.74) mmol/L], Ca [(2.09 ± 0.13) mmol/L vs (2.26 ± 0.19) mmol/L], Mg [(0.74 ±
0.11) mmol/L vs (0.78 ± 0.09) mmol/L], vitamin B 12 (median: 860.20 pmol/L vs 560.31 pmol/L), incidence
of ascites (79.65% vs 27.91%) and incidence of peritonitis (21.24% vs 0.00%) of patients in nutritional risk
groups and non-nutritional risk group were statistically significant (all P ＜ 0.05). Age [(50.81 ± 9.60)
vs (49.42 ± 11.51)], time of alcohol taken [(22.80 ± 9.37) vs (21.42 ± 10.42)], K (median: 3.70 mmol/L vs 3.80 mmol/L),
Fe [(20.07 ± 9.41) μmol/L vs (22.50 ± 10.88) μmol/L], folic acid (median: 16.21 nmol/L vs 16.37 nmol/L),
incidence of hepatic encephalopathy (9.73% vs 4.65%) and incidence of esophageal and gastric fundus varices
(3.54% vs 0.00%) of patients in nutritional risk groups and non-nutritional risk group were not statistically
significant (all P ＞ 0.05). There were 41 cases died in nutrition risk group and 6 cases died in non-nutritional
risk group during the 360-day follow-up. The difference in cumulative survival between the two groups was
statistically significant (χ 2 = 6.718, P = 0.0095). Conclusions Patients with SALD have a high nutritional risk
and need nutritional support treatment according to NRS2002 assessment.
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