Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice
Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice
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DOI：
10.1111/j.1365-2036.2012.05075.x
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发表时间：
2012-05-01
影响因子：
7.6
通讯作者：
Piquet, M.-A.
中科院分区：
文献类型：
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作者：
Dupont, B.;Dao, T.;Piquet, M.-A.
背景营养不良和黄疸是肝硬化的独立预后因素。目的探讨肠内营养对无急性酒精性肝炎的酒精性黄疸患者生存的影响。方法本研究是一项多中心前瞻性随机对照试验，比较肠内营养与对症支持对酒精性肝硬化伴黄疸（胆红素> 51 μ mol/L）但无严重急性酒精性肝炎患者的疗效。共有99例患者随机接受常规对症治疗（55例患者）或对症支持（35 kcal/Kg/d肠内营养，持续4周，随后口服营养支持2个月（44例患者））。根据营养状况对随机化进行分层。使用Kaplan Meier方法和Logrank检验比较1年生存曲线。结果两组人群相似。总体人群的一年生存率相似（肠内营养组27/44例患者（61.4%）vs.（65.5%;对数秩P 0.60）和营养不良亚组[18/29例患者（62.1%）对比对照组20/32（62.5%）;对数秩P 0.991。胆红素、凝血酶原率、Child-Pugh评分、白蛋白或营养评估无统计学差异。治疗期间并发症（出血、脑病、感染）发生率，肠内营养组为23%（10/44），对照组为16%（9/55）（P 0.59）。结论肠内营养并不能改善黄疸患者的生存率和肝功能、营养指标。
Background Malnutrition and jaundice are independent prognostic factors in cirrhosis. Aim To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis.. Methods The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin > 51 j.unol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan Meier method and Logrank test. Results Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P 0.991. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P 0.59). Conclusion Enteral nutrition does not improve the survival and hepatic or nutritional parameters or cirrhotic patients with jaundice.