Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa.
Hepatol Res. 2013 May;43(5):459-66. doi: 10.1111/j.1872-034X.2012.01097.x. Epub 2012 Oct 10.
To test if the treatment adherence to branched-chain amino acid (BCAA) granules influences the serum albumin level and prognosis in prospective 2984 patients with decompensated liver cirrhosis who were prescribed BCAA granules containing 952 mg of L-isoleucine, 1904 mg of L-leucine and 1144 mg of L-valine at 4.15 g/sachet three times a day after meals.
The primary end-point was the time to the event defined as "hospital admission due to progression of hepatic failure", and factors affecting this outcome were explored. Changes in serum albumin level were evaluated as the secondary end-point.
Patients were divided into the good adherence group (those who reported to have taken "nearly all" prescribed doses) and the poor adherence group (those who reported to have taken "approximately half" or "less" doses), because such stratification was validated by treatment responses in plasma BCAA/tyrosine ratio. Factors related to the primary end-point were age, drug adherence during 6 months of study treatment, previous hepatic cancer, current clinical manifestations, previous clinical manifestations, baseline serum albumin level, platelet count and total bilirubin level. The cumulative event-free survival was significantly higher in the good adherence group. Increase in the serum albumin level was also greater in the good adherence group.
Higher BCAA treatment adherence better raised the serum albumin level, leading to improvement of event-free survival. These results indicate the importance of patient instruction for the adequate use of BCAA granules.
检测是否治疗依从性（支链氨基酸[BCAA]颗粒）影响血清白蛋白水平和预后，2984 例失代偿期肝硬化患者，每天 3 次、每次 4.15 袋（含 952mg L-异亮氨酸、1904mg L-亮氨酸和 1144mg L-缬氨酸）BCAA 颗粒治疗，前瞻性研究。
主要终点是时间事件定义为“因肝功能衰竭进展住院”，探索影响这一结果的因素。血清白蛋白水平的变化作为次要终点评估。
患者分为良好依从组（报告服用“几乎所有”规定剂量）和差依从组（报告服用“大约一半”或“更少”剂量），因为这种分层通过血浆 BCAA/酪氨酸比值的治疗反应得到验证。与主要终点相关的因素包括年龄、研究治疗期间的药物依从性、既往肝癌、当前临床表现、既往临床表现、基线血清白蛋白水平、血小板计数和总胆红素水平。良好依从组的累积无事件生存率显著更高。良好依从组的血清白蛋白水平升高也更大。
更高的 BCAA 治疗依从性更好地提高了血清白蛋白水平，从而改善了无事件生存率。这些结果表明，患者指导对于充分使用 BCAA 颗粒非常重要。
