【摘要】：目的:探究肝硬化失代償期患者營養(yǎng)狀況水平,了解經(jīng)頸靜脈肝內(nèi)門體靜脈分流術(shù)(Transjugular Intrahepatic Portosystemic Shunt,TIPS)術(shù)后肝硬化患者的營養(yǎng)狀況是否發(fā)生改變,以及TIPS術(shù)后發(fā)生肝性腦病(Hepatic Encephalopathy,HE)的患者與未發(fā)生HE的患者的人體成分是否存在差異。方法:本次研究最終符合入組要求的患者共58例。采集入組患者TIPS術(shù)前、術(shù)后的生物電阻抗分析(Bioelectrical Impedance Analysis,BIA)結(jié)果,電話隨訪每一位患者術(shù)后一般情況及是否出現(xiàn)HE表現(xiàn)。應(yīng)用配對t檢驗對完成術(shù)前、術(shù)后BIA檢查的患者進(jìn)行人體成分差異顯著性分析;應(yīng)用獨立樣本t檢驗,檢驗發(fā)生HE組患者營養(yǎng)狀況與未發(fā)生HE組患者的營養(yǎng)狀況是否存在顯著性差異。結(jié)果:(1)22例患者完成了術(shù)后第1個月的BIA人體成分分析,術(shù)后患者的腰臀比(0.82土0.04VS0.85±0.05,P0.001)較術(shù)前均顯著下降。(2)20例患者完成了術(shù)后第3個月的BIA人體成分分析,術(shù)后患者的肌肉量(43.26±8.79 VS45.19土8.89Kg,P=0.012),去脂體重(45.98土9.26 VS47.92士9.33Kg,P=0.018),蛋白質(zhì)(8.87±1.83 VS 9.23±1.88Kg,P=0.016),骨骼肌(24.79±5.55 VS 25.86 土 5.66Kg,P=0.019),BCM(29.44± 6.08 VS 30.59 ±6.21Kg,P=0.023)較術(shù)前均有顯著改善。(3)14例患者完成了術(shù)后第6個月的BIA檢查,術(shù)后患者除肌肉量(P0.001),去脂體重(P0.001),蛋白質(zhì)(P0.001),骨骼肌(P0.001),BCM(P0.001)有顯著增加外,上臂周長(29.05±2.56VS30.29±2.24cm,P=0.012),上臂去脂周長(23.91±2.27VS25.23±2.23cm,P0.001)的增加也具有顯著性。(4)TIPS術(shù)后HE組與未發(fā)生HE組兩組之間的人體成分差異不存在統(tǒng)計學(xué)意義。結(jié)論:(1)肝硬化失代償期患者TIPS術(shù)后營養(yǎng)狀況有改善。(2)本研究中,發(fā)生肝性腦病的患者與未發(fā)生肝性腦病的患者在人體成分方面不存在顯著差異。
[Abstract]:Objective: To investigate the nutritional status of patients with decompensated cirrhosis, and to understand whether the nutritional status of patients with cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) has changed, and whether the patients with hepatic encephalopathy (HE) and those without HE have occurred after TIPS. Methods: A total of 58 patients were enrolled in this study. Bioelectrical Impedance Analysis (BIA) was performed before and after TIPS. The general condition and HE appearance of each patient were followed up by telephone. Results: (1) 22 patients completed the body composition analysis of BIA at the first month after surgery, and the waist-to-hip ratio was 0. 82 soil 0.04 VS 0.85 (+ 0.05), P 0.001) were significantly lower than those before surgery. (2) 20 patients completed the BIA body composition analysis at the third month after surgery. The postoperative muscle mass (43.26 (+ 8.79 VS 45.19 soil 8.89 Kg, P = 0.012), fat-free weight (45.98 soil 9.26 VS 47.92 s 9.33 Kg, P = 0.018), protein (8.87 (+ 1.83 VS 9.23 (+ 1.88 Kg, P = 0.016), skeletal muscle mass (24.79 (+ 5.79). 5 VS 25.86 clay 5.66 Kg, P = 0.019, BCM (29.44 + 6.08 VS 30.59 + 6.21 Kg, P = 0.023) were significantly improved compared with preoperative. (3) Fourteen patients completed the BIA examination at the 6th month after surgery, except muscle mass (P 0.001), fat-free weight (P 0.001), protein (P 0.001), skeletal muscle (P 0.001), and BCM (P 0.001), the circumference of the upper arm (29.05 + 2.56V) increased significantly. There was no significant difference in body composition between HE group and non-HE group after TIPS. Conclusion: (1) The nutritional status of patients with decompensated cirrhosis after TIPS was improved. (2) In this study, hepatic encephalopathy occurred. There was no significant difference in body composition between patients with disease and those without hepatic encephalopathy.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2

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