目的:轻度肝性脑病(MHE)反映了肝硬化患者的认知障碍,并与不良预后相关。我们评估了营养治疗对认知功能的影响,健康相关生活质量(HRQOL),人体测量学,内毒素,肝硬化MHE患者的炎症标志物。
方法:在一项双盲随机对照试验中,肝硬化MHE患者随机接受营养治疗(第一组:30-35kcal/kg/天和1.0-1.5g蛋白质/kg/天)和6个月不接受营养治疗(第二组:与患者之前一样饮食)。MHE是根据心理测量肝性脑病评分(PHES)诊断的。人体测量学,氨,内毒素,炎症标志物,肌肉生长抑制素,在基线和6个月后评估HRQOL。主要终点是MHE和HRQOL的改善或恶化。
结果:共有150名患者被随机分为I组(n=75,年龄46.3±12.5岁,58名男性)和II组(n=75,年龄45.2±9.3岁,56名男子)。两组的基线PHES(-8.16±1.42vs-8.24±1.43;P=0.54)具有可比性。I组的MHE逆转率高于II组(73.2%vs21.4%;P=0.001)。PHES的改善(ΔPHES4.0±0.60vs-4.18±0.40;P=0.001),HRQOL(Δ疾病影响曲线3.24±3.63vs0.54±3.58;P=0.001),人体测量学,氨,内毒素,细胞因子,I组的肌肉生长抑制素水平也明显高于II组。I组中有6例患者出现明显的肝性脑病,II组中有13例患者出现(P=0.04)。
结论:营养疗法对MHE的治疗是有效的,并且与营养状况的改善有关。HRQOL,氨,内毒素,炎症标志物,和肌肉生长抑制素水平。
OBJECTIVE: Minimal hepatic encephalopathy (MHE) reflects cognitive impairment in patients with liver cirrhosis and is associated with poor prognosis. We assessed the effects of nutritional therapy on cognitive functions, health-related quality of life (HRQOL), anthropometry, endotoxins, and inflammatory markers in cirrhotic patients with MHE.
METHODS: In a double-blind randomized controlled
trial, cirrhotic patients with MHE were randomized to nutritional therapy (group I: 30-35 kcal/kg/day and 1.0-1.5 g of protein/kg/day) and no nutritional therapy (group II: diet as patients were taking before) for 6 months. MHE was diagnosed based on psychometric hepatic encephalopathy score (PHES). Anthropometry, ammonia, endotoxins, inflammatory markers, myostatin, and HRQOL were assessed at baseline and after 6 months. Primary endpoints were improvement or worsening in MHE and HRQOL.
RESULTS: A total of 150 patients were randomized to group I (n = 75, age 46.3 ± 12.5 years, 58 men) and group II (n = 75, age 45.2 ± 9.3 years, 56 men). Baseline PHES (-8.16 ± 1.42 vs -8.24 ± 1.43; P = 0.54) was comparable in both groups. Reversal of MHE was higher in group I (73.2% vs 21.4%; P = 0.001) than group II. Improvement in PHES (Δ PHES 4.0 ± 0.60 vs -4.18 ± 0.40; P = 0.001), HRQOL (Δ Sickness Impact Profile 3.24 ± 3.63 vs 0.54 ± 3.58; P = 0.001), anthropometry, ammonia, endotoxins, cytokines, and myostatin levels was also significantly higher in group I than group II. Overt hepatic encephalopathy developed in 6 patients in group I and 13 in group II (P = 0.04).
CONCLUSIONS: Nutritional therapy is effective in treatment of MHE and associated with improvement in nutritional status, HRQOL, ammonia, endotoxins, inflammatory markers, and myostatin levels.