Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
Clin Nutr. 2014 Dec;33(6):958-65. doi: 10.1016/j.clnu.2014.02.011. Epub 2014 Mar 6.
BACKGROUND & AIMS: Branched-chain amino acid supplementation in porto-systemic encephalopathy remains controversial. Here, we examined the systematic review evidence for their effect on encephalopathy, hepatic decompensation, survival, infection, hospital stay and quality of life, and review data on adherence, side-effects and cost/economic evaluation.
Four electronic databases were searched from 1980 to June 2011, with an update search in two databases in July 2013. Hand-searching was performed of references lists from included trials and six conference proceedings from 2005 to 2010. We included randomised controlled trials of branched chain amino acids versus other nutritional supplements in adults with cirrhosis and porto-systemic encephalopathy. Data extraction and quality assessment were performed by two independent assessors. Meta-analysis was performed if data were sufficient.
The search identified nine randomised controlled trials (436 patients in total) of branched-chain amino acid therapy for ≥2 weeks' duration. The overall quality of trials was poor. At meta-analysis, a significant improvement in the grade of encephalopathy was demonstrated in favour of branched-chain amino acids compared to other nutritional supplements (Risk Ratio 2.6, 95% Confidence Interval 1.7-3.9, p < 0.001, 2 trials, n 122) but no significant difference was found for either resolution or worsening of encephalopathy, gastrointestinal bleeding, survival or infection. Limited data suggested no difference in health-related quality of life, ascites or admission to hospital. Studies did not include cost data or economic evaluations. Side-effects appeared mild and gastrointestinal in nature.
Branched-chain amino acids might improve porto-systemic encephalopathy but more robust trials are needed to determine their role.
支链氨基酸（branched-chain amino acids，BCAA）补充疗法在门体分流性脑病中的应用仍存在争议。本研究旨在评估 BCAA 对脑病、肝功能失代偿、生存、感染、住院时间和生活质量的影响，并对其用药依从性、不良反应和成本效益评估的相关数据进行综述。
我们检索了 1980 年至 2011 年 6 月间的 4 个电子数据库，并于 2013 年 7 月对其中 2 个数据库进行了更新检索。此外，还对纳入研究的参考文献列表以及 2005 年至 2010 年的 6 次会议论文集进行了手工检索。我们纳入了在肝硬化合并门体分流性脑病患者中，将 BCAA 与其他营养补充剂进行比较的随机对照试验。两名独立评估者对数据提取和质量评估进行了评估。如果数据充分，则进行荟萃分析。
检索共确定了 9 项为期至少 2 周的 BCAA 治疗随机对照试验（共纳入 436 例患者）。试验的总体质量较差。荟萃分析结果显示，与其他营养补充剂相比，BCAA 可显著改善脑病严重程度（风险比 2.6，95%置信区间 1.7-3.9，p<0.001，2 项研究，n=122），但在脑病缓解或恶化、胃肠道出血、生存或感染方面无显著差异。有限的数据提示，BCAA 对健康相关生活质量、腹水或住院治疗无影响。研究未纳入成本数据或经济评估。不良反应表现轻微，主要为胃肠道相关。
BCAA 可能改善门体分流性脑病，但仍需要更有力的试验来确定其作用。
