Xue W X, Yang F, Duan J J, Sun J B, Peng H
Department of Pharmacy, Emergency General Hospital, Beijing 100028, China.
Department of Neurology, Emergency General Hospital, Beijing 100028, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 22;100(47):3793-3800. doi: 10.3760/cma.j.cn112137-20200511-01499.
To investigate the effect of oral administration of branched-chain amino acids (BCAA) supplementation on the mortality of patients with hepatocellular carcinoma (HCC) after treatment. Computer searching of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature Database was conducted to search for clinical controlled trials and randomized controlled trials (RCTs) on the effect of oral administration of BCAA on the mortality of patients with HCC. The retrieval time limit was from the time of the establishment of each database to December 30, 2019. Two researchers independently screened the literature and extracted the data. Another researcher assessed the risk of bias in the included studies and then used RevMan 5.3 software for meta-analysis. A total of 14 studies were included with 1 179 patients. The overall results showed that oral administration of BCAA had no significant effect on the mortality of HCC patients at 1 year after treatment (0.85, 95%0.68-1.06, 0.16), while the mortalities of patients at 3 years (0.73, 95% 0.61-0.88, 0.000 7) and 5 years (0.57, 95%0.34-0.96, 0.03) after treatment were significantly lower than those of the control group. The subgroup analysis showed that for radiofrequency ablation (RFA) patients, there was no significant difference in 1-year mortality between the BCAA group and the control group (0.96, 95:0.14-6.5, 0.97), while 3-year mortality was significantly reduced (0.59, 95%0.43-0.81, 0.001); for hepatectomy patients, there was no significant differences in 1 -and 3-year mortality between the two groups (0.90, 95%0.44-1.88, 0.79; 0.97, 95:0.71-1.33, 0.85, respectively). In addition, as for albumin levels, BCAA supplementation significantly increased albumin levels without considering the treatment of HCC (=0.45, 95: 0.29-0.90; 0.000 1), but had no significant effect on hepatectomy patients (=0, 95: -0.41-0.41, 0.99). BCAA supplementation might improve liver reserve function and long-term prognosis of HCC patients, which was related to the surgical method. Supplementing BCAA reduced the long-term mortality of RFA patients, but had no significant effect on hepatectomy patients.
探讨口服补充支链氨基酸（BCAA）对肝细胞癌（HCC）患者治疗后死亡率的影响。通过计算机检索PubMed、Embase、Cochrane图书馆、中国知网（CNKI）、万方和中国生物医学文献数据库，以查找关于口服BCAA对HCC患者死亡率影响的临床对照试验和随机对照试验（RCT）。检索时间范围为各数据库建库至2019年12月30日。两名研究人员独立筛选文献并提取数据。另一名研究人员评估纳入研究的偏倚风险，然后使用RevMan 5.3软件进行荟萃分析。共纳入14项研究，涉及1179例患者。总体结果显示，口服BCAA对治疗后1年HCC患者的死亡率无显著影响（0.85，95%可信区间0.68 - 1.06，P = 0.16），而治疗后3年（0.73，95%可信区间0.61 - 0.88，P = 0.0007）和5年（0.57，95%可信区间0.34 - 0.96，P = 0.03）患者的死亡率显著低于对照组。亚组分析显示，对于射频消融（RFA）患者，BCAA组与对照组1年死亡率无显著差异（0.96，95%可信区间0.14 - 6.5，P = 0.97），而3年死亡率显著降低（0.59，95%可信区间0.43 - 0.81，P = 0.001）；对于肝切除患者，两组1年和3年死亡率均无显著差异（分别为0.90，95%可信区间0.44 - 1.88，P = 0.79；0.97，95%可信区间0.71 - 1.33，P = 0.85）。此外，就白蛋白水平而言，补充BCAA可显著提高白蛋白水平，无论是否进行HCC治疗（P = 0.45，95%可信区间0.29 - 0.90；P = 0.0001），但对肝切除患者无显著影响（P = 0.99，95%可信区间 - 0.41 - 0.41）。补充BCAA可能改善HCC患者的肝脏储备功能和长期预后，这与手术方式有关。补充BCAA可降低RFA患者的长期死亡率，但对肝切除患者无显著影响。
