Malaguarnera Mariano, Bella Rita, Vacante Marco, Giordano Maria, Malaguarnera Giulia, Gargante Maria Pia, Motta Massimo, Mistretta Antonio, Rampello Liborio, Pennisi Giovanni
Department of Senescence, Urological and Neurological Sciences, University of Catania, Ospedale Cannizzaro, Catania, Italy.
Scand J Gastroenterol. 2011 Jun;46(6):750-9. doi: 10.3109/00365521.2011.565067. Epub 2011 Mar 28.
Minimal hepatic encephalopathy (MHE) represents a common complication present in well-compensated cirrhotic patients that impairs patients' daily functioning and health-related quality of life (HRQL). Acetyl-L-carnitine (ALC) has been shown to be useful in improving blood ammonia and cognitive functions in cirrhotic patients with MHE.
This study evaluated the effects of ALC treatment on HRQL and depression in patients with MHE.
This was a randomized, double-blind, placebo-controlled study. Sixty-seven patients with MHE were recruited to the study. They were randomly assigned to two groups and received either 2 g acetyl-L-carnitine twice a day (n = 33) or placebo (n = 34) for 90 days. The primary efficacy measures were changes in aspartate aminotransferase, alanine aminotransferase, γ-glutamyl-transpeptidase, albumin, alkaline phosphatase, prothrombin time, and ammonia. Clinical and laboratory assessments, psychometric tests and automated electroencephalogram (EEG) analysis were performed for all patients.
At the end of the study period, between the two groups, we observed a significant difference in physical function (p < 0.001), role physical (p < 0.001), general health (p < 0.001), social function (p < 0.05), role emotional (p < 0.05), mental health (p < 0.05), Beck Depression Inventory (p < 0.001), TMT-B s (p < 0.001), State Trait Inventory (p < 0.001), urea (p < 0.05), NH(4)(+) (p < 0.001), and bilirubin (p < 0.001).
This study shows that ALC treatment is associated with significant improvement in patient energy levels, general functioning and well-being. The improvement of quality of life is associated with reduction of anxiety and depression.
轻微肝性脑病（MHE）是代偿良好的肝硬化患者中常见的并发症，会损害患者的日常功能和健康相关生活质量（HRQL）。已证明乙酰-L-肉碱（ALC）有助于改善患有MHE的肝硬化患者的血氨水平和认知功能。
本研究评估了ALC治疗对MHE患者HRQL和抑郁的影响。
这是一项随机、双盲、安慰剂对照研究。67例MHE患者被纳入研究。他们被随机分为两组，每天两次接受2 g乙酰-L-肉碱（n = 33）或安慰剂（n = 34）治疗90天。主要疗效指标为天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转肽酶、白蛋白、碱性磷酸酶、凝血酶原时间和氨的变化。对所有患者进行了临床和实验室评估、心理测试及自动脑电图（EEG）分析。
在研究期结束时，两组之间在身体功能（p < 0.001）、身体角色（p < 0.001）、总体健康（p < 0.001）、社会功能（p < 0.05）、情感角色（p < 0.05）、心理健康（p < 0.05）、贝克抑郁量表（p < 0.001）、TMT-B s（p < 0.001）、状态特质量表（p < 0.001）、尿素（p < 0.05）、NH(4)(+)（p < 0.001）和胆红素（p < 0.001）方面存在显著差异。
本研究表明，ALC治疗与患者能量水平、总体功能和幸福感的显著改善相关。生活质量的提高与焦虑和抑郁的减轻相关。
