朱　慧，郭红英，黄大青，张宇一，张正国，邹　颖，王介非，钱志平

·肝硬化·

添加羊乳粉对乙型肝炎肝硬化患者营养状态及肝脏合成功能的影响

朱慧，郭红英，黄大青，张宇一，张正国，邹颖，王介非，钱志平

目的探讨羊乳粉对乙型肝炎肝硬化患者营养状态及肝脏合成功能的影响。方法选取我科诊治的乙型肝炎肝硬化患者80例，按患者意愿分为羊乳粉营养支持治疗组40例和常规饮食对照组40例。所有患者均参照2006年欧洲肠外肠内营养学会制定的肝病肠内营养指南给予总热量35 kcal·kg-1·d-1，蛋白质的摄入量为1.2～1.5 kcal·kg-1·d-1。治疗组患者除正常饮食外，每日分别于晨起空腹和睡前各给予卡布瑞克羊乳粉30 g，加60℃温水冲服，1次/d，服用12 w。分别于4 w、8 w和12 w测定患者体质指数、上臂肌围，检测外周血白蛋白、前白蛋白、转铁蛋白、胆碱酯酶、总胆红素、血氨、甘油三酯、空腹血糖水平。应用SPSS 16.0统计软件，两组间计量资料的比较采用t检验。结果在第4 w和第8 w时，两组患者体质指数和上臂肌围的差异均无统计学意义（P>0.05）；在第12 w时，治疗组患者体质指数为（23.36±1.26）kg/m2，显著高于对照组[（22.30±1.80）kg/m2，t=3.021，P<0.05]，上臂肌围为（27.89±2.85）cm，显著高于对照组[（26.16±3.04）cm，t=2.766，P<0.05]，白蛋白为（34.93±1.63）g/L，显著高于对照组[（32.04±1.80）g/L，t=7.597，P<0.05]，前白蛋白为（91.97±21.14）mg/L，显著高于对照组[（76.92±15.94）mg/L，t=3.415，P<0.05]，转铁蛋白为（1.69±0.35）mg/L，显著高于对照组[（1.50±0.34）mg/L，t=2.315，P<0.05]和胆碱酯酶为（2785±516）U/L，显著高于对照组[（2546±487）U/L，t=2.105，P<0.05]；而与对照组比，治疗组患者血清总胆红素、血氨、甘油三酯和空腹血糖水平无统计学差异。结论添加羊乳粉能有效改善乙型肝炎肝硬化患者的营养状况，提高肝脏的合成功能。

肝硬化；乙型肝炎；羊乳粉；营养

【Abstracts】ObjectiveTo observe the effects of goat milk powder diet on nutrition condition and synthetic function of liver in patients with hepatitis B-induced liver cirrhosis.MethodsEighty patients with hepatitis B-related liver cirrhosis were enrolled in this study，and 40 cases were treated with goat milk powder in treatment group and 40 cases were treated with regular dieteric were treatment in control group.Evaluation of nutrition condition andliver function tests were conducted for 12 weeks in both groups.Analyses were carried out by using t test.ResultsAt 4 week and 8 week observation，there was no significant difference of nutrition indicators and liver synthetic funtion，including body mass index，arm muscle circumference，serum albumin，pre-albumim，transferrin and cholinesterase levels between the two groups；the body mass index[（23.36±1.26）kg/m2vs.（22.30±1.80）kg/m2，t=3.021，P<0.05]，arm muscle circumstance[（27.89±2.85）cm vs.（26.16±3.04）cm，t=2.766，P< 0.05]，albulmin[（34.93±1.63）g/L vs.（32.04±1.80）g/L，t=7.597，P<0.05]，pre-albulmin[（91.97±21.14）mg/L vs.（76.92±15.94）mg/L，t=3.415，P<0.05]，transferrin[（1.69±0.35）mg/L vs.（1.50±0.34）mg/L，t=2.315，P<0.05]and cholinesterase[（2785±516）U/L vs.（2546±487）U/L，t=2.105，P<0.05]in the treatment group at week 12 were significantly increased as compared to those in the control group，while the serum levels of total bilirubin，blood ammonia，plasmatriglycerideandbloodsugarshowednosignificantdifferencesbetweenthetwogroups. ConclusionsDietary intervention with goat milk powder can improve nutrition condition and liver synthetic function in patients with hepatitis B-induced liver cirrhosis.

【Key words】Liver cirrhosis；Hepatitis B；Goat milk powder；Nutrition

肝硬化患者普遍存在营养不良，以蛋白质-热量营养不良最为常见[1]。营养不良不仅是肝硬化的并发症，而且与疾病的自然转归及近期和远期预后都密切相关。营养支持治疗是肝硬化患者内科综合治疗中极其重要的组成部分[2，3]，国内外指南均推荐优先考虑肠内营养。本研究在日常饮食的基础上，探索添加羊乳粉肠内营养粉剂对肝硬化患者营养状况及肝脏合成功能的影响。