transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2010-0-3-4-13-17transplantologiya-288Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSОценка статуса питания и методы его коррекции у больных, включенных в «Лист ожидания» трансплантации печениAssessment of nutritional status and methods for its correction in patients on the waiting list for liver transplantationКиселевВ. В.KiselevV. V.ЖуравельС. В.ZhuravelS. V.

Сергей Владимирович Журавель

sjuravel@rambler.ruЧжаоА. В.ChzhaoA. V.НИИ скорой помощи им Н.В. Склифосовского, Московский центр трансплантации печениРоссияN.V. Sklifosovsky Research Institute of Emergency Care; Moscow Liver Transplantation CenterRussian Federation20101708201803-41317Copyright © Киселев В.В., Журавель С.В., Чжао А.В., 20182018Киселев В.В., Журавель С.В., Чжао А.В.Kiselev V.V., Zhuravel S.V., Chzhao A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/288

Цель исследования — разработка рациональных способов коррекции питательного статуса у пациентов с диффузными заболеваниями печени, находящихся в «Листе ожидания» (ЛО) трансплантации печени (ТП).

Материалы и методы

Материалы и методы. Проведено комплексное обследование 82 пациентов с циррозом печени (ЦП), включенных в ЛО ТП и распределенных по 3 группам. Пациенты были сопоставимы по возрасту, полу и тяжести состояния. Во всех группах исследовали показатели питательного статуса, энерготрат. Для оценки нарушений в статусе питания использовались комплексные методы расчета показателей питательного статуса, энерготрат и потребности в питательных веществах.

Результаты и обсуждение

Результаты и обсуждение. При проведении оценки статуса питания, метаболизма и питательной терапии у 64 (78%) пациентов в ЛО ТП выявлены нарушения. Нормальный статус питания был определен у 18 (22%) пациентов, белковоэнергетические нарушения легкой степени тяжести были выявлены у 18 (22%), средней степени — у 40 (48,8%) и тяжелой — у 6 (7,3%) пациентов. Больным с нарушением питания средней и тяжелой степени дополнительно к диетическому питанию перорально назначались сбалансированные питательные смеси (СПС). Для коррекции дисбаланса аминокислотного состава крови 10 пациентам назначался гепамин в комплексной терапии печеночной энцефалопатии. На фоне проводимой терапии отмечалось достоверное снижение уровня аммиака в сыворотке и улучшение показателей психометрического тестирования.

Выводы и практические рекомендации. При постановке пациентов с ЦП в ЛО ТП и при поступлении пациентов в стационар для оперативного вмешательства необходимо выполнить комплексную оценку состояния питания и установить степень недостаточности питания. Больным с недостаточностью питания средней и тяжелой степени, а также с осложнениями послеоперационного периода необходимо составить индивидуальный план питательной поддержки.

Objective

Objective: to develop rational modes of nutritional status correction in patients with diffuse liver diseases on the liver transplantation (LT) waiting list (WL).

Subjects and methods

Subjects and methods. A comprehensive examination was made in 82 patients with hepatic cirrhosis who were included into the LT WL and allocated to 3 groups. The patients were matched for age, gender, and the severity of their condition. Nutritional status parameters and energy expenditures were studied in all the groups. Complex methods to calculate nutritional status parameters, energy expenditures, and nutrient needs were used to evaluate malnutrition.

Results and discussion

Results and discussion. Assessment of nutritional status, metabolism, and nutritional therapy revealed disorders in 64 (78%) patients on the LT WL. Normal nutritional status was found in 18 (22%) patients; mild, moderate, and severe protein-energy malnutrition was detectable in 18 (22%), 40 (48.8%), and 6 (7.3%) patients, respectively. The patients with moderate and severe malnutrition were given oral balanced feeding formulas in addition to diet therapy. To correct imbalance of blood amino acid composition, 10 patients were given hepamin in combination therapy for hepatic encephalopathy. During the performed therapy, there was a significant reduction in serum ammonia levels and improved psychometric testing results.

Conclusion and practical guidelines. When HC patients are referred to the LT WL and admitted to hospital for surgery, it is necessary to make an integrated assessment of nutritional status and to define the degree of malnutrition. An individual nutritional support plan must be complied for patients with moderate and severe malnutrition and for those with postoperative complications.

печеночная энцефалопатиягепаминпитательный статусцирроз печенитрансплантация печениhepatic encephalopathyhepaminnutritional statushepatic cirrhosisliver transplantationReferencesKeeffe E.B., Gettys C., Esquivel C.O. Liver transplantation in patients with severe obesity. Transplantation 1994;57:309–11.Keeffe E.B., Gettys C., Esquivel C.O. Liver transplantation in patients with severe obesity. Transplantation 1994;57:309–11.Hasse J.M., Matarese L. E.Solid Organ Transplantation. The A.S.P.E.N. Nutrition Support Core Curriculum: A case-based approach — the adult patient. USA: American Society for Parenteral and Enteral Nutrition 2007;600–61.Hasse J.M., Matarese L. E.Solid Organ Transplantation. The A.S.P.E.N. Nutrition Support Core Curriculum: A case-based approach — the adult patient. USA: American Society for Parenteral and Enteral Nutrition 2007;600–61.Fan S.T., Lo C.M., Lai E.C. et al. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 1994;331:1547–52.Fan S.T., Lo C.M., Lai E.C. et al. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 1994;331:1547–52.Weimann A., Braga M., Harsanyi L. et al. ESPEN Guidelines of Enteral Nutrition: Surgery including Organ Transplantation. Clinical Nutrition 2006;25:224–44.Weimann A., Braga M., Harsanyi L. et al. ESPEN Guidelines of Enteral Nutrition: Surgery including Organ Transplantation. Clinical Nutrition 2006;25:224–44.Harrison J., McKiemann J., Neuberger J.M. A prospective study on the effect of recipient nutritional status on outcome in liver transplantation. Transplantation 1997;10:369–74.Harrison J., McKiemann J., Neuberger J.M. A prospective study on the effect of recipient nutritional status on outcome in liver transplantation. Transplantation 1997;10:369–74.Shronts E.P., Teasley K.M., Thoele S.L., Cerra FB. Nutrition support of the adult liver transplant candidate. J Am Diet Assoc 1987;87:441–51.Shronts E.P., Teasley K.M., Thoele S.L., Cerra FB. Nutrition support of the adult liver transplant candidate. J Am Diet Assoc 1987;87:441–51.Müller M.J., Willmann O., Rieger A. et al. Mechanism of insulin resistance associated with liver cirrhosis. Gastroenterology 1992; 102:2033–41.Müller M.J., Willmann O., Rieger A. et al. Mechanism of insulin resistance associated with liver cirrhosis. Gastroenterology 1992; 102:2033–41.Delich P.C., Siepler J.K., Parker P. Liver Disease. The A.S.P.E.N. Nutrition Support Core Curriculum: A case-based approach – the adult patient. USA: American Society for Parenteral and Enteral Nutrition 2007;541–55.Delich P.C., Siepler J.K., Parker P. Liver Disease. The A.S.P.E.N. Nutrition Support Core Curriculum: A case-based approach – the adult patient. USA: American Society for Parenteral and Enteral Nutrition 2007;541–55.Plevak D.J., DiCecco S.R., Wiesner R.H. et al. Nutritional support for liver transplantation: identifying caloric and protein requirements. Mayo Clin Proc 1994;69:225–300.Plevak D.J., DiCecco S.R., Wiesner R.H. et al. Nutritional support for liver transplantation: identifying caloric and protein requirements. Mayo Clin Proc 1994;69:225–300.Levine R.J., Conn H.O. Tyrosine metabolism in patients with liver disease. J Clin Invest 1967;46:2012–20.Levine R.J., Conn H.O. Tyrosine metabolism in patients with liver disease. J Clin Invest 1967;46:2012–20.Gabuzda G.L., Shear L. Metabolism of dietary protein in hepatic cirrhosis. Am. J Clin Nutr 1970;23:479–87.Gabuzda G.L., Shear L. Metabolism of dietary protein in hepatic cirrhosis. Am. J Clin Nutr 1970;23:479–87.Payne-James J.J., De Gara C.J., Grimble G.K. et al. Nutritional support in hospitals in the United Kingdom: National Survey 1988. Health Trends 1990;22:9–13.Payne-James J.J., De Gara C.J., Grimble G.K. et al. Nutritional support in hospitals in the United Kingdom: National Survey 1988. Health Trends 1990;22:9–13.Iber F.L., Rosen H., Levenson S.M. et al. The plasma amino acids in patients with liver failure. J Lab Clin Med 1957;50:417–25.Iber F.L., Rosen H., Levenson S.M. et al. The plasma amino acids in patients with liver failure. J Lab Clin Med 1957;50:417–25.Fong Y., Marano M.A., Barber A. et al. Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg 1989;210:449–57.Fong Y., Marano M.A., Barber A. et al. Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg 1989;210:449–57.Naylor C.D., O'Rourke K., Detsky A.S. et al. Parenteral nutrition with branched chain amino acids in hepatic encephalopathy: A metaanalysis. Gastroenterology 1989;97:1033–42.Naylor C.D., O'Rourke K., Detsky A.S. et al. Parenteral nutrition with branched chain amino acids in hepatic encephalopathy: A metaanalysis. Gastroenterology 1989;97:1033–42.Campillo B., Bories P.N., Leluan M. et al. De’penses e’nergetiques et utilisation des nutriments chez le cirrhotique a’ jeun et au repos. Influence de l'he’patite alcolique et du score de gravite’ de la maladie. Gastroenterol Clin Biol 1989;13:544–50.Campillo B., Bories P.N., Leluan M. et al. De’penses e’nergetiques et utilisation des nutriments chez le cirrhotique a’ jeun et au repos. Influence de l'he’patite alcolique et du score de gravite’ de la maladie. Gastroenterol Clin Biol 1989;13:544–50.Seeler R.A., Hahn K. Jaundice in urinary tract infection in infancy. Am J Dis Child 1969;118:553–8.Seeler R.A., Hahn K. Jaundice in urinary tract infection in infancy. Am J Dis Child 1969;118:553–8.Shanbhogue R.L., Bistrian B.R., Jenkins R.L. et al. Increased protein catabolism without hypermetabolism after human orthotopic liver transplantation. Surgery 1987;101:146–9.Shanbhogue R.L., Bistrian B.R., Jenkins R.L. et al. Increased protein catabolism without hypermetabolism after human orthotopic liver transplantation. Surgery 1987;101:146–9.Shanbhogue R.L.K., Bistrian B.R., Jenkins R.L. et al. Resting energy expenditure in patients with end-stage liver disease and in normal population. JPEN 1987;11:305–8.Shanbhogue R.L.K., Bistrian B.R., Jenkins R.L. et al. Resting energy expenditure in patients with end-stage liver disease and in normal population. JPEN 1987;11:305–8.Merli M., Riggio O., Romiti A. et al. Basal energy production rate and substrate use in stable cirrhotic patients. Hepatology 1990;12:106–12.Merli M., Riggio O., Romiti A. et al. Basal energy production rate and substrate use in stable cirrhotic patients. Hepatology 1990;12:106–12.Muller M.J., Fenk A., Lautz H.U. et al. Energy expenditure and substrate metabolism in ethanol-induced liver cirrhosis. Am J Physiol 1991;260:E338–44.Muller M.J., Fenk A., Lautz H.U. et al. Energy expenditure and substrate metabolism in ethanol-induced liver cirrhosis. Am J Physiol 1991;260:E338–44.Müller M.J., Boker K., Selberg O. Metabolism of energy yielding substrates in patients with liver cirrhosis. Clin Invest 1994;72:568–79.Müller M.J., Boker K., Selberg O. Metabolism of energy yielding substrates in patients with liver cirrhosis. Clin Invest 1994;72:568–79.Selberg O., Bottcher J., Tusch G. et al. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology 1997;25(3):652–7.Selberg O., Bottcher J., Tusch G. et al. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology 1997;25(3):652–7.Figueiredo F., Dickson E.R., Pasha T. et al. Impact of nutritional status on outcomes after liver transplantation. Transplantation 2000;70(9):1347–52.Figueiredo F., Dickson E.R., Pasha T. et al. Impact of nutritional status on outcomes after liver transplantation. Transplantation 2000;70(9):1347–52.

The authors declare that there are no conflicts of interest present.