基于NRS营养风险评估的整蛋白型肠内营养对老年肝硬化患者营养状态、肠道菌群及外周血Th17/Treg平衡的影响

摘要 目的：探讨基于营养风险筛查（NRS）营养风险评估的整蛋白型肠内营养对老年肝硬化患者营养状态、肠道菌群及外周血辅助性T细胞17（Th17）/调节性T细胞（Treg）平衡的影响。方法：按照随机数字表法将2019年12月~2022年8月期间长沙市第一医院收治的103例老年肝硬化患者将患者分为对照组（常规饮食治疗，51例）和研究组（对照组基础上接受基于NRS营养风险评估的整蛋白型肠内营养治疗，52例）。比较两组NRS2002评分、营养状态指标、肠道菌群指标及外周血Th17/Treg平衡变化情况。结果：治疗3个月后，两组NRS2002评分下降，且研究组低于对照组（P<0.05）。治疗3个月后，两组血清总蛋白（TP）、白蛋白（ALB）及前白蛋白（PA）升高，且研究组高于对照组（P<0.05）。治疗3个月后，两组双歧杆菌、乳酸杆菌、肠球菌、肠杆菌升高，且研究组高于对照组（P<0.05）。治疗3个月后，两组酵母样真菌下降，且研究组低于对照组（P<0.05）。治疗3个月后，两组Treg升高，且研究组高于对照组（P<0.05），治疗3个月后，两组Th17、Th17/Treg下降，且研究组低于对照组（P<0.05）。结论：老年肝硬化患者经基于NRS营养风险评估的整蛋白型肠内营养治疗，有利于降低营养不良发生风险，可能与改善患者的营养状态、肠道菌群及外周血Th17/Treg平衡有关。

Effect of Total Protein Enteral Nutrition Base on NRS Nutritional Risk Assessment on Nutritional Status, Intestinal Flora and Peripheral Blood Th17/Treg Balance in Elderly Patients with Cirrhosis

ABSTRACT Objective: To investigate the effects of total protein enteral nutrition base on nutritional risk screening (NRS) nutritional risk assessment on nutritional status, intestinal flora and peripheral blood T helper cell 17(Th17)/regulatory T cell (Treg) balance in elderly patients with cirrhosis. Methods: 103 elderly patients with liver cirrhosis admitted to the First Hospital of Changsha from December 2019 to August 2022 were divided into the control group (51 cases were treated with conventional diet) and the study group (52 cases were treated with whole protein enteral nutrition based on NRS nutrition risk assessment on the basis of the control group) according to the method of random number table. The changes of NRS2002 score, nutritional status index, intestinal flora index and peripheral blood Th17/Treg balance were compared between two groups. Results: Three months after treatment, the NRS2002 score decreased in two groups, and study group was lower than that of control group(P<0.05). Three months after treatment, serum total protein (TP), albumin (ALB) and prealbumin (PA) increased in two groups, and study group was higher than that of control group(P<0.05). Three months after treatment, bifidobacteria, lactobacilli, enterococci and enterobacteria increased in two groups, and study group was higher than that of control group(P<0.05). Three months after treatment, yeast like fungi decreased in two groups, and study group was lower than that of control group(P<0.05). Three months after treatment, Treg increased in two groups, and study group was higher than that of control group(P<0.05). Three months after treatment, Th17 and Th17/Treg decreased in two groups, and study group was lower than that of control group(P<0.05). Conclusion: Total protein enteral nutrition base on NRS nutritional risk assessment in elderly patients with cirrhosis, which is beneficial to reduce the risk of malnutrition, may be relate to the improvement of nutritional status, intestinal flora and peripheral blood Th17/ Treg balance.