术前补充β-羟-β-甲基丁酸、精氨酸和谷氨酰胺联合治疗对心脏手术后恢复的评估：一项双盲随机安慰剂对照临床试验。
Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine: a double-blind randomized placebo-controlled clinical trial.
机构信息
Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Shohadaye gomnam BLD., ALEM square, Yazd, Iran.
Department of Nutrition, International Campus of Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
出版信息
Trials. 2022 Aug 13;23(1):649. doi: 10.1186/s13063-022-06621-1.
BACKGROUND
The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients' underlying surgery. In some medical conditions, supplementation with a combination of L-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and L-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery.
METHODS
This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g L-arginine, 7 g L-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery.
RESULTS
In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group.
CONCLUSION
The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial.
TRIAL REGISTRATION
IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.
背景
术前是改善营养状况、补充营养缺乏和优化患者基础手术免疫功能的好时机。在某些医疗条件下，补充 L-谷氨酰胺（Gln）、β-羟基-β-甲基丁酸（HMB）和 L-精氨酸（Arg）的组合对改善恢复有很好的效果。本研究旨在评估 Gln/Arg/HMB 补充剂在心脏手术患者中的作用。
方法
这是一项对 70 名接受心脏手术的患者进行的随机临床试验。要求参与者在手术前 30 天每天服用 2 袋 7 克 L-精氨酸、7 克 L-谷氨酰胺和 1.5 克 HMB 的混合物或安慰剂。在基线和研究结束时，测量左心室射血分数以及肌钙蛋白、肌酸磷酸激酶（CPK）、CPK-MB、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和胆红素的血清水平。此外，手术后记录了Sequential Organ Failure Assessment（SOFA）评分、住院和重症监护病房（ICU）的停留时间以及术后并发症。
结果
共有 60 名术前患者（每组 30 名）完成了研究，平均年龄为 53.13±14.35 岁（失访率=85.7%）。Gln/Arg/HMB 组患者的 CPK-MB（中位数[IQR]：49[39.75] vs. 83[64.55]；P=0.011）、肌钙蛋白（中位数[IQR]：2.13[1.89] vs. 4.34[1.99]；P<0.001）、胆红素（中位数[IQR]：0.50[0.20] vs. 0.40[0.22]；P<0.001）和 SOFA 评分（中位数[IQR]：2[2] vs. 5[2]；P<0.001）在研究结束时均低于安慰剂组。此外，Gln/Arg/HMB 组患者的住院时间（中位数[IQR]：5[1] vs. 6[3]；P<0.001）和 ICU 停留时间（中位数[IQR]：2.50[1.00] vs. 3.50[1.50]；P=0.002）也较低。
结论
本研究表明，心脏手术患者围手术期补充 Gln、Arg 和 HMB 可促进恢复、减轻心肌损伤，并缩短住院和 ICU 停留时间。这些结果需要在更大的试验中得到证实。
试验注册
IRCT.ir IRCT20120913010826N31. 于 2020 年 10 月 13 日注册。
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