Ishikawa Yoshinori, Yoshida Hiroshi, Mamada Yasuhiro, Taniai Nobuhiko, Matsumoto Satoshi, Bando Koichi, Mizuguchi Yoshiaki, Kakinuma Daisuke, Kanda Tomohiro, Tajiri Takashi
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2010 May-Jun;57(99-100):583-90.
BACKGROUND/AIMS: Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver.
In this prospective, randomized, controlled trial, 38 patients were assessed for eligibility. Fourteen patients were excluded because they had received intraoperative blood transfusions or incomplete resections. The 24 eligible patients (20 with malignant liver tumors and 4 with benign liver tumors) were randomly assigned to receive perioperative ON with BCAA (11 patients, BCAA group) or a usual diet (13 patients, control group). The BCAA group received a BCAA supplement twice daily plus a usual diet for 14 days before operation and on days 1 to 7 after operation. The control group received a usual diet alone. The primary end point was the improvement in postoperative biochemical measurements.
Two of the 11 patients in the BCAA group developed postoperative complications, as compared with 3 of the 13 patients in the control group (18.2% vs. 23.1%, p = 0.7686). Serum levels of alanine aminotransferase, aspartate aminotransferase, and ammonia did not differ significantly between the BCAA group and control group; however, peak values were lower in the BCAA group. There was no difference between the groups in serum hemoglobin levels after operation. Among patients with hepatitis, serum erythropoietin (EPO) levels on POD 3, 5, and 7 were slightly but not significantly higher in the BCAA group than in the control group. Among patients with non-hepatitis, serum EPO levels on POD 3, 5, and 7 were significantly higher in the BCAA group than in the control group (p = 0.0174, p = 0.0141, and p = 0.0328, respectively).
Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis.
背景/目的：早期前瞻性随机临床试验表明，围手术期给予支链氨基酸（BCAA）的肠外营养（PN）对接受肝切除术的肝细胞癌肝硬化患者有益。然而，PN支持费用昂贵且需要较长的住院时间。此外，尚未对接受肝切除术的肝功能正常患者进行PN支持评估。本研究旨在探讨围手术期给予BCAA进行口服营养（ON）对接受肝切除术患者（包括非肝炎性肝病患者）的益处。
在这项前瞻性、随机、对照试验中，评估了38例患者的 eligibility。14例患者被排除，因为他们接受了术中输血或切除不完全。24例符合条件的患者（20例患有恶性肝肿瘤，4例患有良性肝肿瘤）被随机分配接受围手术期BCAA的ON（11例患者，BCAA组）或常规饮食（13例患者，对照组）。BCAA组在术前14天及术后第1至7天每天接受两次BCAA补充剂加常规饮食。对照组仅接受常规饮食。主要终点是术后生化指标的改善。
BCAA组11例患者中有2例发生术后并发症，而对照组13例患者中有3例发生（18.2%对23.1%，p = 0.7686）。BCAA组和对照组血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶和氨水平无显著差异；然而，BCAA组的峰值较低。术后两组血清血红蛋白水平无差异。在肝炎患者中，BCAA组术后第3、5和7天的血清促红细胞生成素（EPO）水平略高于对照组，但无显著差异。在非肝炎患者中，BCAA组术后第3、5和7天的血清EPO水平显著高于对照组（分别为p = 0.0174、p = 0.0141和p = 0.0328）。
在接受根治性肝切除术的非肝炎患者中，短期BCAA的ON支持比正常饮食能使血清EPO水平更高。较高的EPO水平可能有助于保护肝细胞免受缺血性损伤，并预防术中出血，同时血清中围手术期丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平较低。这是第一项证明BCAA的肠内营养支持对非肝炎患者以及肝炎患者有效果的研究。
