富含亮氨酸的饮食补充剂可快速有效改善接受肠内管饲的急性脑卒中患者的营养不良。
Quick and effective improvement of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding.
机构信息
Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.
出版信息
BMC Emerg Med. 2020 Jul 20;20(1):56. doi: 10.1186/s12873-020-00351-w.
BACKGROUND
Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly increase serum levels of albumin (Alb) or transthyretin (TTR) and decrease high-sensitivity C-reactive protein (CRP) in the development of severe malnutrition within a few days after stroke onset compared to standard BCAA dietary supplement (SBDs).
METHODS
We retrospectively included acute stroke patients who: 1) were admitted between August 2016 and July 2017; 2) underwent ETF for 7 days or longer after admission, and 3) underwent blood examination of Alb, TTR, and CRP on admission, the fifth day and the seventh day. We defined severe malnutrition as severe hypoproteinemia: decrease of TTR to less than 15 mg/dl on the 5th day. In LEBDs and SBDs groups, patients started to receive a dietary supplement containing leucine of 1.44 and 0. 72 g twice a day on the fifth day, respectively. We evaluated Alb (g/dl), TTR (mg/dl), and CRP (mg/dl) on admission, the fifth day, and the seventh day.
RESULTS
Twenty-nine patients met our inclusion criteria:15 in LEBDs and 14 in SBDs. In LEBDs and SBDs groups, the median Alb was 3.5 and 3.3 g/dl, TTR was 12.7 and 10.7 mg/dl, and CRP was 1.02 and 0.673 mg/dl on admission, respectively. In LEBDs, the median Alb and TTR decreased to 2.6 g/dl and 11.9 mg/dl, and CRP increased to 5.337 mg/dl on the fifth day. On the 7th day, TTR increased, and CRP decreased, although Alb did not improve. In SBDs, the median Alb and TTR decreased to 2.6 g/dl and 9.7 mg/dl, and CRP increased to 4.077 mg/dl on the fifth day. On the 7th day, Alb, TTR, and CRP did not improve.
CONCLUSION
In acute stroke patients receiving leucine enriched BCAA dietary supplement, quick improvements in transthyretin and CRP were observed.
背景
接受肠内管饲（ETF）的急性中风患者常发生营养不良。除非改善营养不良，否则其临床预后较差。但是，尚未确定改善这些患者营养不良的策略。支链氨基酸（BCAA）可能会增强蛋白质合成并减轻炎症。我们的研究旨在探讨与标准 BCAA 膳食补充剂（SBDs）相比，富含亮氨酸的 BCAA 膳食补充剂（LEBDs）是否可以在中风发作后几天内迅速增加血清白蛋白（Alb）或转甲状腺素（TTR）水平，并降低高敏 C 反应蛋白（CRP）水平，从而在数天内改善严重营养不良的发展。
方法
我们回顾性纳入了急性中风患者：1）在 2016 年 8 月至 2017 年 7 月期间入院；2）入院后接受 ETF 治疗 7 天或更长时间；3）入院时，第 5 天和第 7 天接受 Alb、TTR 和 CRP 血液检查。我们将严重低蛋白血症定义为第 5 天 TTR 下降至<15mg/dl。在 LEBDs 和 SBDs 组中，患者分别在第 5 天开始每天两次摄入含有 1.44 和 0.72g 亮氨酸的膳食补充剂。我们评估了入院时、第 5 天和第 7 天的 Alb（g/dl）、TTR（mg/dl）和 CRP（mg/dl）。
结果
共有 29 名患者符合纳入标准：LEBDs 组 15 名，SBDs 组 14 名。在 LEBDs 和 SBDs 组中，入院时 Alb 的中位数分别为 3.5 和 3.3g/dl，TTR 分别为 12.7 和 10.7mg/dl，CRP 分别为 1.02 和 0.673mg/dl。在 LEBDs 组中，第 5 天时 Alb 和 TTR 中位数降至 2.6g/dl 和 11.9mg/dl，CRP 增至 5.337mg/dl。第 7 天时，TTR 升高，CRP 下降，尽管 Alb 没有改善。在 SBDs 组中，第 5 天时 Alb 和 TTR 中位数降至 2.6g/dl 和 9.7mg/dl，CRP 增至 4.077mg/dl。第 7 天，Alb、TTR 和 CRP 没有改善。
结论
在接受富含亮氨酸的 BCAA 膳食补充剂的急性中风患者中，TTR 和 CRP 迅速改善。
Zotero 插件