Kalia Shivam, Nath Preetam, Pathak Mona, Anand Anil C
Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha 751024, India.
Department of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha 751024, India.
J Clin Exp Hepatol. 2022 May-Jun;12(3):980-992. doi: 10.1016/j.jceh.2021.10.147. Epub 2021 Nov 2.
Muscle cramps are witnessed in 22-88% of patients with cirrhosis of liver and frequently lead to sleep disturbance with an appalling impact on quality of life. Despite such a high prevalence, there is lack of evidence-based management protocol due to scarcity of trials on treatment options in the literature. This study aimed to review systematically the available therapeutic options for muscle cramps in patients with cirrhosis of liver.
A systematic review of the relevant databases (PubMed, Scopus, Embase, and Web of Science) to identify treatments for muscle cramps in patients with hepatic cirrhosis was performed. Studies meeting the selection criteria were reviewed and assessed for risk of bias and analyzed.
Twenty-four publications were identified as eligible for inclusion in this systematic review. Seven randomized controlled trials (RCTs) and 17 prospective studies were included. Taurine, methocarbamol, baclofen, and orphenadrine are relatively safer and effective treatment option for muscle cramps in cirrhosis on the basis of recently conducted RCTs. Moreover, l-carnitine, branched-chain amino acids (BCAAs), pregabalin, zinc, and vitamin D are also safe and showed beneficial effects on muscle cramps. However, studies on vitamin E revealed contradictory results.
Taurine, BCAAs, orphenadrine, and baclofen are safe and well-tolerated treatment options for muscle cramps in cirrhosis. However, well-designed randomized controlled clinical trials are the need of the hour to determine the most suitable treatment options for skeletal muscle cramps in patients with cirrhosis of liver.
22% - 88%的肝硬化患者会出现肌肉痉挛，这常常导致睡眠障碍，对生活质量产生严重影响。尽管患病率如此之高，但由于文献中关于治疗方案的试验稀缺，缺乏基于证据的管理方案。本研究旨在系统回顾肝硬化患者肌肉痉挛的现有治疗选择。
对相关数据库（PubMed、Scopus、Embase和Web of Science）进行系统回顾，以确定肝硬化患者肌肉痉挛的治疗方法。对符合入选标准的研究进行回顾、评估偏倚风险并分析。
确定了24篇符合纳入本系统评价的文献。包括7项随机对照试验（RCT）和17项前瞻性研究。根据最近进行的RCT，牛磺酸、美索巴莫、巴氯芬和奥芬那君是治疗肝硬化肌肉痉挛相对更安全有效的选择。此外，左旋肉碱、支链氨基酸（BCAAs）、普瑞巴林、锌和维生素D也安全且对肌肉痉挛有有益作用。然而，关于维生素E的研究结果相互矛盾。
牛磺酸、BCAAs、奥芬那君和巴氯芬是治疗肝硬化肌肉痉挛安全且耐受性良好的选择。然而，目前急需设计良好的随机对照临床试验来确定肝硬化患者骨骼肌痉挛最合适的治疗方案。
