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摘要：
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摘要：目的 探讨整蛋白型肠内营养对老年肝硬化患者营养指标、NRS2002评分、肝功能及并发症
的影响。方法 选取2015年3月至2019年3月文昌市人民医院收治的148例老年肝硬化患者为研究对
象，采用随机数字表法分为观察组和对照组，每组74例。对照组进行常规饮食，观察组在常规饮食
的基础上加用整蛋白型肠内营养剂，两组连续干预6个月。比较两组患者治疗前后体重指数（body
mass indes，BMI）、白蛋白（albumin，ALB）、前白蛋白（prealbumin，PA）、凝血酶原活动度
（prothrombin activity，PTA）、淋巴细胞计数（total lymohocyte count，TLC）、丙氨酸氨基转移
酶（alanine aminotransferase，ALT）、总胆红素（total bilirubin，TBil）及凝血酶原时间（plasma
prothrombin time，PT）的差异。采用NRS2002评分筛查两组患者营养风险。记录治疗期间消化道出
血、肝肾综合征、肝性脑病及继发感染等并发症发生情况。结果 治疗前，观察组和对照组患者BMI
[（19.07 ± 2.80）kg/m2 vs（19.15 ± 2.56）kg/m2
]、ALB [（32.78 ± 2.81）g/L vs（31.94 ± 2.84）g/L]、PA
[（98.06 ± 18.84）mg/L vs（99.74 ± 19.60）mg/L]、PTA [（54.82 ± 19.54）% vs（53.79 ± 18.68）%]
及TLC [（1.21 ± 0.92）× 109
/L vs（1.23 ± 1.02）× 109
/L]水平差异无统计学意义（P均＞ 0.05）。
治疗后，观察组患者BMI [（22.14 ± 2.52）kg/m2 vs（20.97 ± 2.37）kg/m2
]、ALB [（36.25 ± 2.66）g/L vs
（34.89 ± 2.88）g/L]、PA [（109.17 ± 17.64）mg/L vs（101.46 ± 16.51）mg/L]及PTA [（66.30 ±
20.30）% vs（56.14 ± 19.28）%]水平显著高于对照组，差异有统计学意义（P均＜ 0.05），TLC
[（1.11 ± 0.94）× 109
/L vs（1.21 ± 0.82）× 109
/L]水平差异无统计学意义（t = 0.690，P = 0.491）。
治疗前，两组患者存在营养不良风险的比例差异无统计学意义[2.70%（2/74）vs 5.41%（4/74）；χ
2 =
0.174，P = 0.677]，治疗后，观察组存在营养不良风险的比例显著低于对照组[40.54%（30/74）vs
94.59%（70/74）；χ
2 = 49.333、P ＜ 0.001]。治疗后，两组患者存在营养不良风险的比例均显著高
于治疗前，差异有统计学意义（χ
2 = 31.259、117.730，P均＜ 0.001）。治疗前，观察组和对照组患者ALT
[（77.15 ± 20.54）U/L vs（69.58 ± 19.97）U/L]、TBil [（50.70 ± 15.25）μmol/L vs（49.26 ± 12.60）μmol/L]
及PT [（19.13 ± 2.65）s vs（19.76 ± 2.36）s]水平差异无统计学意义（P均＞ 0.05）。治疗后，观察
组ALT水平[（39.83 ± 11.32）U/L vs（34.51 ± 12.17）U/L]显著高于对照组，TBil [（22.95 ± 8.53）μmol/L
vs（33.85 ± 11.93）μmol/L]和PT [（14.76 ± 1.64）s vs（18.87 ± 1.59）s]水平显著低于对照组，差异
有统计学意义（P均＜ 0.05）。两组患者治疗后ALT、TBil及PT水平均显著低于治疗前，差异有统计
学意义（P均＜ 0.05）。在治疗期间，观察组肝性脑病[4.05%（3/74）vs 18.92%（14/74）]和继发感
染[8.11%（6/74）vs 25.68%（19/74）]的发生率显著低于对照组，差异有统计学意义（χ
2
= 6.646、
8.134，P = 0.010、0.004）；消化道出血[6.76%（5/74）vs 10.81%（8/74）]及肝肾综合征[2.70%
（2/74）vs 6.76%（5/74）]发生率差异无统计学意义（P = 0.384、0.245）。结论 整蛋白型肠内营养
可改善老年肝硬化患者营养不良及肝功能，降低其营养风险率，可有效预防并发症的发生，值得临
床推广。
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Abstract: Objective To investigate the effects of whole protein enteral nutrition on nutritional indexes,
NRS 2002, liver function and complications on elderly patients with liver cirrhosis. Methods A total of 148
elderly patients with liver cirrhosis admitted in Wenchang City People’s Hospital from March 2015 to March
2019 were selected and divided into observation group and control group according to random number
table method, 74 cases in each group. Patients in control group carried on the routine diet, while patients
in observation group took the whole protein type enteral nutrition agent on the basis of control group, the
patients were continuously intervened for 6 months. The body mass indes (BMI), albumin (ALB), prealbumin
(PA), prothrombin activity (PTA), total lymohocyte count (TLC), alanine aminotransferase (ALT), total
bilirubin (TBil) and plasma prothrombin time (PT) levels of patients in two groups before and after treatment
were compared. The nutritional risk of patients in two groups were screened by NRS2002 score method. The
complications of gastrointestinal bleeding, hepatorenal syndrome, hepatic encephalopathy and secondary
infection were recorded. Results Before treatment, there were no significant differences in BMI [(19.07 ±
2.80) kg/m2 vs (19.15 ± 2.56) kg/m2
], ALB [(32.78 ± 2.81) g/L vs (31.94 ± 2.84) g/L], PA [(98.06 ± 18.84) mg/L
vs (99.74 ± 19.60) mg/L], PTA [(54.82 ± 19.54) % vs (53.79 ± 18.68) %] and TLC [(1.21 ± 0.92) × 109
/L
vs (1.23 ± 1.02) × 109
/L] levels of patients in observation group and control group (all P ＞ 0.05). After
treatment, BMI [(22.14 ± 2.52) kg/m2 vs (20.97 ± 2.37) kg/m2
], ALB [(36.25 ± 2.66) g/L vs (34.89 ± 2.88) g/L], PA
[(109.17 ± 17.64) mg/L vs (101.46 ± 16.51) mg/L] and PTA [(66.30 ± 20.30)% vs (56.14 ± 19.28)%] levels
of patients in observation group were significantly higher than those in control group, the differences were
statistically significant (all P ＜ 0.05), there was no statistically significant difference in TLC [(1.11 ± 0.94) ×
109
/L vs (1.21 ± 0.82) × 109
/L] level between the two groups (t = 0.690, P = 0.491). Before treatment, there
was no significant difference in the proportion of malnutrition risk between the two groups [2.70% (2/74) vs
5.41% (4/74); χ
2 = 0.174, P = 0.677]. After treatment, the proportion of malnutrition risk in observation group
was significantly lower than that in control group [40.54% (30/74) vs 94.59% (70/74); χ
2 = 49.333, P < 0.001].
After treatment, the proportion of patients with malnutrition risk in both groups were significantly higher than
those before treatment, and the differences were statistically significant (χ
2 = 31.259, 117.730, all P ＜ 0.001).
Before treatment, there were no significant differences in ALT [(77.15 ± 20.54) U/L vs (69.58 ± 19.97) U/L],
TBil [(50.70 ± 15.25) μmol/L vs (49.26 ± 12.60) μmol/L] and PT [(19.13 ± 2.65) s vs (19.76 ± 2.36) s] levels
of patients in observation group and control group (all P ＞ 0.05). After treatment, ALT level of patients in
observation group was significantly higher than that of control group [(39.83 ± 11.32) U/L vs (34.51 ± 12.17) U/L], while
TBil [(22.95 ± 8.53) μmol/L vs (33.85 ± 11.93) μmol/L] and PT [(14.76 ± 1.64) s vs (18.87 ± 1.59) s] levels
were significantly lower than those of control group, the differences were statistically significant
(all P ＜ 0.05). After treatment, the levels of ALT, TBil and PT of patients in two groups were significantly
lower than those before treatment, the differences were statistically significant (all P ＜ 0.05). During the
treatment period, the incidence of hepatic encephalopathy [4.05% (3/74) vs 18.92% (14/74)] and secondary
infection [8.11% (6/74) vs 25.68% (19/74)] of patients in observation group were significantly lower than
those of control group, the differences were statistically significant (χ
2
= 6.646, 8.134; P = 0.010, 0.004).
There were no significant differences in the incidence of gastrointestinal bleeding [6.76% (5/74) vs 10.81%
(8/74)] and hepatorenal syndrome [2.70% (2/74) vs 6.76% (5/74)] between the two groups (P = 0.384, 0.245).
Conclusions Whole protein enteral nutrition can improve the malnutrition and liver function of elderly
patients with liver cirrhosis, reduce the rate of nutritional risk and effectively prevent the occurrence of
complications, which is worthy of clinical promotion.
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