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摘要：
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摘要：目的 评估老年肝硬化患者营养风险及临床特征，分析老年肝硬化患者合并营养风险的危险因
素。方法 回顾性收集2018年8月至2019年8月于首都医科大学附属北京地坛医院住院的285例老年肝硬
化患者为研究对象。采用营养风险筛查量表（nutritional risk screening，NRS）2002对患者进行营养风险
评估，根据营养风险评分将患者分为无营养风险组（NRS 2002 ＜ 3分）和营养风险组（NRS 2002 ≥
3分），比较两组年龄、性别、肝硬化、Child-Pugh分级、肝肾综合征发生率、腹水发生率、腹腔感染
发生率、白蛋白（albumin，ALB）、总胆红素（total bilirubin，TBil）、凝血酶原时间（prothrombin
time，PT）延长时间、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移
酶（aspartate aminotransferase，AST）及血红蛋白（hemoglobin，HGB）等指标的差异。采用多因素
Logistic回归分析老年肝硬化患者合并营养风险的危险因素。结果 本研究共纳入285例患者，其中无营
养风险组93例，营养风险组192例。无营养风险组和营养风险组患者年龄（中位数：66岁vs 67岁）、
性别（男/女：49/44 vs 117/75）、肝硬化失代偿期比例[94.6%（88/93）vs 97.4%（187/192）]、肝性
脑病发生率[2.2%（2/93）vs 2.1%（4/192）]、肝肾综合征发生率[10.8%（10/93）vs 19.3%（37/192）]
及腹腔感染发生率[4.3%（4/93）vs 8.9%（17/192）]差异无统计学意义（P均＞ 0.05），腹水发生率
[48.4%（45/93）vs 78.1%（150/192）]及体重指数（body mass index，BMI）分布（过低/正常/超重：
2例/41例/50例vs 18例/94例/80例）差异有统计学意义（P均＜ 0.05）。无营养风险组和营养风险组患
者Child-Pugh分级（A级/B级/C级：47例/31例/15例vs 34例/98例/60例）、ALB [（35.20 ± 5.95）g/L vs
（30.25 ± 5.34）g/L]、TBil（中位数：23.70 μmol/L vs 30.30 μmol/L）、PT延长时间（中位数：1.10 s vs
2.20 s）、AST（中位数：33.70 U/L vs 40.80 U/L）、HGB [（117.53 ± 24.30）g/L vs（104.25 ± 25.44）g/L]和
住院时间（中位数：10.00 d vs 11.00 d）的差异有统计学意义（P均＜ 0.05），ALT水平差异无统计学
意义（中位数：25.20 U/L vs 23.45 U/L；t = -0.057，P = 0.955）。多因素Logstic回归分析表明，腹水
为老年肝硬化患者合并营养风险的危险因素（OR = 2.224，95%CI：1.233～4.011，P = 0.008），ALB
为保护因素（OR = 0.876，95%CI：0.830～0.925，P ＜ 0.001）。结论 老年肝硬化患者合并营养风险
并发症发生率高，肝功能差，病情重，住院时间长。腹水是老年肝硬化患者合并营养风险的危险因
素，ALB为保护因素。
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Abstract: Objective To investigate the nutritional risk and clinical features of elderly patients with liver
cirrhosis and to analyze the risk factor of elderly liver cirrhosis patients complicated with nutritional risk.
Methods Total of 285 elderly patients with liver cirrhosis in Beijing Ditan Hospital, Capital Medical
University from August 2018 to August 2019 were retrospectively collected. Nutritional risk screening (NRS)
2002 was used to estimate the nutritional risk of the patients. The patients were divided into non-nutrition risk
group (NRS 2002 score ＜ 3) and nutrition risk group (NRS 2002 score ≥ 3) according to the score of NRS
2002. The age, gender, Child-Pugh grade, rate of hepatorenal syndrome, rate of ascites, rate of abdominal
infection, albumin (ALB), total bilirubin (TBil), prolonged prothrombin time (PT), alanine aminotransferase
(ALT), aspartate aminotransferase (AST) and hemoglobin (HGB) of patients in two groups were compared.
Multivariate Logistic regression analysis was used to analyze the factors affecting elderly liver cirrhosis
patients complicated with nutritional risk. Results A total of 285 patients were included, there were 93 cases
in non-nutrition risk group and 192 cases in nutrition risk group. Age (median: 66 years vs 67 years), gender
(male/female: 49/44 vs 117/75), ratio of decompensated liver cirrhosis [94.6% (88/93) vs 97.4% (187/192)],
incidence of hepatic encephalopathy [2.2% (2/93) vs 2.1% (4/192)], incidence of hepatorenal syndrome [10.8%
(10/93) vs 19.3% (37/192)] and incidence of abdominal cavity infection [4.3% (4/93) vs 8.9% (17/192)] of
patients in non-nutrition risk group and nutrition risk group had no statistically significant differences (all P ＞
0.05). The incidence of ascites [48.4% (45/93) vs 78.1% (150/192)] and BMI (underweight/normal weight/
overweight: 2 cases/41 cases/50 cases vs 18 cases/94 cases/80 cases) of patients in non-nutrition risk group
and nutrition risk group were statistically significant (all P ＜ 0.05). Child-Pugh grade (grade A/grade B/grade C:
47 cases/31 cases/15 cases vs 34 cases/98 cases/60 cases), ALB [(35.20 ± 5.95) g/L vs (30.25 ± 5.34) g/L], TBil
(median: 23.70 μmol/L vs 30.30 μmol/L), prolonged PT (median: 1.10 s vs 2.20 s), AST (median: 33.70 U/L vs
40.80 U/L), HGB [(117.53 ± 24.30) g/L vs (104.25 ± 25.44) g/L] and hospital stay (median:10.00 d vs 11.00 d) of
patients in non-nutrition risk group and nutrition risk group were statistically significant (all P ＜ 0.05). There
were no significant difference in ALT (median: 25.20 U/L vs 23.45 U/L) of patients in non-nutrition risk group
and nutrition risk group (t = -0.057, P = 0.955). Multivariate Logistic regression analysis showed that ascites
was a risk factor (OR = 2.224, 95%CI: 1.233～4.011, P = 0.008) and ALB was a protective factor (OR =
0.876, 95%CI: 0.830～0.925, P ＜ 0.001) for elderly liver cirrhosis patients complicated with nutritional risk.
Conclusions Elderly liver cirrhosis patients were with high incidence of nutritional risk complications, poor
liver function, serious condition and long hospital stay. Ascites was a risk factor and albumin was a protective
factor for elderly liver cirrhosis patients complicated with nutrition risk.
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