营养风险对轻微肝性脑病预后的影响

Impact of Nutritional Risk on the Prognosis of Minimal Hepatic Encephalopathy

摘要: 目的：分析轻微肝性脑病的发生与营养风险的相关关系，探究营养风险对轻微肝性脑病患者预后的影响。方法：本研究选取2025年10月至2026年2月期间，在青岛大学附属医院消化内科、肝病内科及肝胆外科住院治疗的112例肝硬化患者为对象。收集其一般资料与相关实验室指标，并采用数字连接试验及数字符号试验对轻微肝性脑病进行筛查诊断，采用营养风险筛查量表NRS2002、英国皇家自由医院营养优先工具(the royal free hospital-nutritional prioritizing tool, RFH-NPT)评估患者营养风险，采用终末期肝病预测模型(model for end-stage liver disease score, MELD)评估患者预后。计数资料采用χ²检验，计量资料采用t检验，并采用多因素线性回归方法分析营养风险、BMI、白蛋白与MELD评分的关系。结果：轻微肝性脑病(n = 54)与无轻微肝性脑病患者(n = 58)性别、年龄、肝功能分级、BMI、白蛋白差异均有统计学意义(P值分别为：0.030，0.002，0.018，0.022，0.004，均小于0.05)，而肝硬化病因、是否因消化道出血入院、营养风险、甘油三酯、总胆固醇、血钾、血钠、血氯差异无统计学意义(P值分别为：0.273，0.910，0.317 [NRS2002]，0.391 [RFH-NPT]，0.321，0.212，0.092，0.250，0.706，均大于0.05)。营养风险与MELD评分存在线性回归关系，尚不能认为BMI、白蛋白与MELD评分存在线性回归关系。结论：营养风险与轻微肝性脑病发生不存在相关性，但会影响患者预后。

Abstract: Objective: The objective of this study was to investigate the association between nutritional risk and the presence of minimal hepatic encephalopathy (MHE), and to explore the impact of nutritional risk on the prognosis of patients with MHE. Methods: This study enrolled 112 patients with liver cirrhosis hospitalized in the Gastroenterology, Hepatology, and Hepatobiliary Surgery departments of the Affiliated Hospital of Qingdao University during the period from October 2025 to February 2026. Information on basic demographics and laboratory findings was gathered. For the detection of MHE, we applied the number connection test in conjunction with the digit symbol test. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS2002) and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH‑NPT). Patient prognosis was evaluated using the Model for End‑stage Liver Disease (MELD) score. Categorical data were analyzed using the chi‑square test, and continuous data were analyzed using the t‑test. Multivariate linear regression was used to analyze the relationships of nutritional risk, body mass index (BMI), and albumin with the MELD score. Results: There were statistically significant differences between the MHE group (n = 54) and the non‑MHE group (n = 58) in sex, age, liver function classification, BMI, and albumin (P values: 0.030, 0.002, 0.018, 0.022, and 0.004, respectively; all P < 0.05). However, no statistically significant differences were found in etiology of cirrhosis, admission due to gastrointestinal bleeding, nutritional risk, triglycerides, total cholesterol, serum potassium, serum sodium, or serum chloride (P values: 0.273, 0.910, 0.317 [NRS2002], 0.391 [RFH‑NPT], 0.321, 0.212, 0.092, 0.250, and 0.706, respectively; all P > 0.05). A linear regression relationship was observed between nutritional risk and MELD score, whereas no linear regression relationship was found between BMI or albumin and MELD score. Conclusion: Nutritional risk is not correlated with the occurrence of MHE, but it does affect patient prognosis.