左旋肉碱补充治疗肝硬化患者的生存获益。

Survival benefit of l-carnitine supplementation in patients with cirrhosis.

机构信息

Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.

Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan.

出版信息

JPEN J Parenter Enteral Nutr. 2022 Aug;46(6):1326-1334. doi: 10.1002/jpen.2386. Epub 2022 May 22.

DOI:10.1002/jpen.2386

PMID:35511698

Abstract

BACKGROUND

l-Carnitine supplementation is effective in improving muscle cramps, hyperammonemia, and hepatic encephalopathy in patients with cirrhosis. However, limited evidence is available on the effect of l-carnitine supplementation on the survival of patients with cirrhosis.

METHODS

In this retrospective study, 674 patients with cirrhosis admitted to Gifu University Hospital or Chuno Kosei Hospital between October 2011 and December 2018 were enrolled. l-carnitine supplementation was defined as the use of l-carnitine for >30 consecutive days during the follow-up period. Propensity score matching was applied to create comparable groups between l-carnitine-treated and untreated patients. Mortality was evaluated using the Cox proportional hazards model.

RESULTS

Among the patients, 93 were excluded. Of the remaining 581 patients, 71 (12%) received l-carnitine supplementation. Propensity matching identified 189 patients (63 l-carnitine-treated and 126 untreated patients) with comparable baseline characteristics in both groups. Of the matched patients, 33 (52%) l-carnitine-treated and 74 (59%) untreated patients died during the median follow-up period of 36.3 months. Overall survival was significantly higher in l-carnitine-treated patients than in untreated patients (hazard ratio [HR], 0.66; 95% CI, 0.43-0.99). A subgroup analysis showed that the survival benefit of l-carnitine supplementation was prominent in patients with Child-Pugh Class B or C (HR, 0.39; 95% CI, 0.23-0.68), serum albumin levels ≤3.5 g/dl (HR, 0.59; 95% CI, 0.37-0.95), and ammonia levels ≥90 mcg/dl (HR, 0.50; 95% CI, 0.26-0.97), and in those without sarcopenia (HR, 0.56; 95% CI, 0.35-0.90).

CONCLUSION

l-Carnitine supplementation may improve survival in patients with cirrhosis.

摘要

背景

左旋肉碱补充剂可有效改善肝硬化患者的肌肉痉挛、高血氨症和肝性脑病。然而，关于左旋肉碱补充剂对肝硬化患者生存的影响，目前仅有有限的证据。

方法

在这项回顾性研究中，共纳入了 2011 年 10 月至 2018 年 12 月期间在岐阜大学医院或鹑野医院就诊的 674 例肝硬化患者。将左旋肉碱补充定义为在随访期间连续使用左旋肉碱>30 天。采用倾向评分匹配法在接受和未接受左旋肉碱治疗的患者之间创建可比组。采用 Cox 比例风险模型评估死亡率。

结果

在患者中，排除了 93 例。在其余的 581 例患者中，71 例（12%）接受了左旋肉碱补充。倾向匹配确定了 189 例患者（左旋肉碱治疗组 63 例，未治疗组 126 例），两组患者的基线特征具有可比性。在匹配的患者中，33 例（52%）左旋肉碱治疗组和 74 例（59%）未治疗组在中位随访 36.3 个月期间死亡。左旋肉碱治疗组的总体生存率明显高于未治疗组（风险比[HR]，0.66；95%置信区间，0.43-0.99）。亚组分析显示，在 Child-Pugh 分级为 B 或 C（HR，0.39；95%置信区间，0.23-0.68）、血清白蛋白水平≤3.5 g/dl（HR，0.59；95%置信区间，0.37-0.95）和血氨水平≥90 mcg/dl（HR，0.50；95%置信区间，0.26-0.97）的患者以及无肌少症的患者（HR，0.56；95%置信区间，0.35-0.90）中，左旋肉碱补充的生存获益更为显著。