Kikuchi Yutaro, Hiroshima Yukihiko, Matsuo Kenichi, Kawaguchi Daisuke, Murakami Takashi, Yabushita Yasuhiro, Endo Itaru, Taguri Masataka, Koda Keiji, Tanaka Kuniya
Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Ann Surg Oncol. 2016 Oct;23(11):3727-3735. doi: 10.1245/s10434-016-5348-3. Epub 2016 Jun 23.
Massive postoperative ascites remains a major threat that can lead to liver failure and other fatal complications, especially in patients with poor liver function. Branched-chain amino acid (BCAA) administration increases biosynthesis and secretion of albumin by hepatocytes and increases oncotic pressure by elevating blood albumin concentration, thereby decreasing peripheral edema, ascites, and pleural effusion.
We randomly allocated consecutive patients undergoing major liver resection for hepatocellular carcinoma to either a group where oral BCAA administration was initiated 3 weeks before liver resection, or a non-BCAA group. The primary study endpoint was development of postoperative ascites.
Overall, 39 patients were allocated to the BCAA group, while 38 were assigned to the non-BCAA group. No significant difference in the rate of refractory ascites, considered alone, was evident between the BCAA (5.1 %) and non-BCAA groups (13.2 %; p = 0.263). However, the occurrence of refractory ascites and/or pleural effusion was significantly less frequent in the BCAA group (5.1 %) than in the non-BCAA group (21.1 %; p = 0.047). Furthermore, the postoperative serum concentration of reduced-state albumin was greater immediately after liver resection in the BCAA group than in the non-BCAA group.
Preoperative administration of BCAA did not significantly improve prevention of refractory ascites, but significant effectiveness in preventing ascites, pleural effusion, or both, as well as improving metabolism of albumin, was demonstrated [University Hospital Medical Information Network (UMIN) reference number 000004244].
大量术后腹水仍然是一个主要威胁，可导致肝功能衰竭和其他致命并发症，尤其是在肝功能较差的患者中。给予支链氨基酸（BCAA）可增加肝细胞白蛋白的生物合成和分泌，并通过提高血白蛋白浓度增加胶体渗透压，从而减少外周水肿、腹水和胸腔积液。
我们将连续接受肝细胞癌大肝切除术的患者随机分为两组，一组在肝切除术前3周开始口服BCAA，另一组为非BCAA组。主要研究终点是术后腹水的发生情况。
总体而言，39例患者被分配到BCAA组，38例被分配到非BCAA组。单独考虑难治性腹水发生率时，BCAA组（5.1%）和非BCAA组（13.2%）之间无明显差异（p = 0.263）。然而，BCAA组（5.1%）难治性腹水和/或胸腔积液的发生率明显低于非BCAA组（21.1%；p = 0.047）。此外，肝切除术后即刻BCAA组还原型白蛋白的术后血清浓度高于非BCAA组。
术前给予BCAA并不能显著改善难治性腹水的预防，但在预防腹水、胸腔积液或两者兼有的情况以及改善白蛋白代谢方面显示出显著效果[大学医院医学信息网络（UMIN）参考编号000004244]。
