Gastroenterology Center.
Department of Rehabilitation, Ehime Prefectural Central Hospital, Matsuyama.
Eur J Gastroenterol Hepatol. 2019 Jul;31(7):878-884. doi: 10.1097/MEG.0000000000001368.
The aim of this study was to elucidate the efficacy of the combination of L-carnitine and exercise, reported to prevent muscle wasting, for muscle complications (function, volume, and cramping) in patients with liver cirrhosis (LC) who received branched-chain amino acid supplementation.
From December 2017 to April 2018, 18 patients with LC who had been given branched-chain amino acid granule supplementation (12.45 g/day) were enrolled (mean age 68.4±10.8 years; 10 males and eight females; Child-Pugh A : B=9 : 9). After evaluating the average number of daily steps, oral L-carnitine supplementation (1000 mg/day) and additional exercise (plus 2000 steps/day) were added for 6 months. Every 4 weeks, a pedometer, a hand dynamometer, ergometer, and bioelectrical impedance analysis were used to evaluate daily steps, muscle function and muscle volume, and muscle cramps were recorded using a numerical rating scale.
Average steps and serum levels of total and free carnitine were increased from before treatment to the final measurement (1883.5±1211.6 vs. 3165.1±1800.0/day, 62.6±16.5 vs. 110.9±28.6 μmol/l, and 47.7±15.2 vs. 83.2±21.5 μmol/l, respectively; P<0.01), whereas there were no significant changes in the ratios of handgrip strength, leg strength, and muscle volume after 6 months [1.00±0.13 (P=0.991), 1.07±0.13 (P=0.073), and 0.992±0.036 (P=0.390), respectively]. However, the frequency of complaints of muscle cramping was reduced as compared with the start of therapy (baseline, 3 months, and 6 months: 6.3±4.8, 3.1±3.3, and 2.1±2.0, respectively) (P=0.025, Holm's method), whereas numerical rating scale did not show any significant improvement.
L-Carnitine may have an important role for prevention of muscle wasting and reducing the frequency of muscle cramping.
本研究旨在阐明左旋肉碱与运动相结合的疗效，据报道，左旋肉碱与运动相结合可预防肌肉减少症，用于预防肝硬化（LC）患者的肌肉并发症（功能、体积和痉挛），这些患者接受了支链氨基酸补充。
2017 年 12 月至 2018 年 4 月，纳入了 18 名接受支链氨基酸颗粒补充（12.45g/天）的 LC 患者（平均年龄 68.4±10.8 岁；男性 10 名，女性 8 名；Child-Pugh A:B=9:9）。在评估每日平均步数后，给予口服左旋肉碱补充（1000mg/天）和额外运动（增加 2000 步/天），持续 6 个月。每 4 周，使用计步器、握力计、测力计和生物电阻抗分析评估每日步数、肌肉功能和肌肉体积，并使用数字评分量表记录肌肉痉挛。
从治疗前到最后一次测量，平均步数和总游离肉碱的血清水平均升高（1883.5±1211.6 比 3165.1±1800.0/天，62.6±16.5 比 110.9±28.6μmol/l，和 47.7±15.2 比 83.2±21.5μmol/l，分别；P<0.01），而 6 个月后手握力、腿部力量和肌肉体积的比值无明显变化[1.00±0.13（P=0.991），1.07±0.13（P=0.073）和 0.992±0.036（P=0.390）]。然而，与治疗开始时相比，肌肉痉挛的投诉频率降低（基线、3 个月和 6 个月：6.3±4.8、3.1±3.3 和 2.1±2.0，分别）（P=0.025，Holm 法），而数字评分量表没有显示任何显著改善。
左旋肉碱可能在预防肌肉减少症和减少肌肉痉挛的发生频率方面发挥重要作用。
