探究肝移植患者MELD评分与术后营养状态的关系

Exploring the Relationship between MELD Score and Postoperative Nutritional Status in Liver Transplant Patients

摘要: 目的：探讨肝移植患者终末期肝病模型(MELD)与术后营养状态的关系，以期为临床提供更精确的评估工具和管理策略。方法：收集2019年1月至2023年7月于本中心接受肝移植术的99例患者的临床资料，使用腰大肌身高指数对患者术后生存及营养状态进行预测；依据病因、MELD评分进行亚组分析。结果：少肌症组和无少肌症组在年龄、白蛋白水平、L₃-PMI以及生存时间上有统计学意义(p < 0.05)。MELD评分亚组中，肝恶性肿瘤患者L₃-PMI为A组3.51 ± 0.75、B组2.47 ± 0.76、C组2.76 ± 0.96，酒精性肝硬化患者L₃-PMI为A组3.13 ± 0.45、B组2.25 ± 0.28、C组3.01 ± 1.92，A与B组之间比较差异有统计学意义(p < 0.05)，其余组间无统计学意义；乙肝肝硬化失代偿患者L₃-PMI为A组3.74 ± 0.83、B组2.88 ± 0.53、C组2.09 ± 0.36，三组组间比较均有统计学意义(p < 0.05)。结论：L₃-PMI可以有效评价患者营养状况和术后生存状态；MELD评分与术后营养状况存在显著的相关性，高MELD评分的患者往往术后营养状况较低，容易发生营养障碍。

Abstract: Objective: To explore the relationship between end-stage liver disease (MELD) model and postoperative nutritional status in liver transplant patients, in order to provide more accurate assessment tools and management strategies for clinical practice. Method: Clinical data of 99 patients who underwent liver transplantation at our center from January 2019 to July 2023 were collected, and the lumbar muscle height index was used to predict the postoperative survival and nutritional status of the patients; Perform subgroup analysis based on etiology and MELD score. Result: There were statistically significant differences (p < 0.05) in age, albumin levels, L₃-PMI, and survival time between the sarcopenia group and the non sarcopenia group. In the MELD scoring subgroups, the L₃-PMI of patients with liver malignant tumors was 3.51 ± 0.75 in group A, 2.47 ± 0.76 in group B, and 2.76 ± 0.96 in group C. The L₃-PMI of patients with alcoholic cirrhosis was 3.13 ± 0.45 in group A, 2.25 ± 0.28 in group B, and 3.01 ± 1.92 in group C. There was a statistically significant difference between group A and group B (p < 0.05), while there was no statistically significant difference between the other groups; The L₃-PMI of decompensated patients with hepatitis B cirrhosis was 3.74 ± 0.83 in group A, 2.88 ± 0.53 in group B, and 2.09 ± 0.36 in group C. The comparison among the three groups was statistically significant (p < 0.05). Conclusion: L₃-PMI can effectively evaluate the nutritional status and postoperative survival status of patients; There is a significant correlation between MELD score and postoperative nutritional status. Patients with high MELD scores often have lower postoperative nutritional status and are prone to nutritional disorders.