补充支链氨基酸对肝硬化进展具有有益作用：一项荟萃分析。
Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis: A meta-analysis.
作者信息
Du Jia-Yu, Shu Liu, Zhou Yu-Tian, Zhang Li
机构信息
School of Clinical Medicine, Chengdu Medical College, Chengdu 610000, Sichuan Province, China.
Department of Neuroscience, College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China.
出版信息
World J Clin Cases. 2022 Oct 26;10(30):10984-10996. doi: 10.12998/wjcc.v10.i30.10984.
BACKGROUND
Liver cirrhosis (LC) is currently the 11 most common cause of death and 15 cause of morbidity globally. The treatment of LC is mainly aimed at etiological intervention, lifestyle intervention, prevention and treatment of complications and nutritional treatment. Nutritional treatment of LC mainly includes increasing dietary intake, food intake time and branched-chain amino acids (BCAAs). Despite the recommendation of BCAAs in some guidelines, adverse effects have been reported in studies so the efficacy and safety of BCAAs remain controversial. Currently, BCAAs have been widely used in chronic liver disease, while the summary of the effect of BCAAs on long-term prognosis is rare.
AIM
To determine the effects of BCAAs in patients with LC.
METHODS
The PubMed, Cochrane Library, Embase and Web of Science databases were searched. The retrieval deadline was 1 October 2021 and there were no language restrictions set in the retrieval. The study was performed in strict accordance with the inclusion and exclusion criteria. Nine studies were finally included. The primary outcome was complications of LC. The secondary outcomes were nutritional status and liver function. This meta-analysis used the Review Manager, version 5 statistical package (Cochrane Collaboration, Oxford, England) for analysis.
RESULTS
The analysis included nine studies that consisted of 1080 patients (554 in the BCAA groups and 526 in the control groups). The nine studies were randomized control trials (RCTs). The quality of the studies was assessed using the risk of bias method recommended by the Cochrane Collaboration. BCAAs reduced the rate of complications in LC patients [Risk ratio: 0.70, 95% confidence interval (CI): 0.56-0.88, = 0.002] and improved patients' albumin levels [std mean difference SMD: 0.26, 95%CI: 0.12-0.40, = 0.0002]. Meanwhile, BCAAs significantly ameliorated the levels of alanine transaminase (SMD: -2.03, 95%CI: -2.52 to -1.53, < 0.00001) and aspartate aminotransferase (SMD: -1.8, 95%CI: -2.14 to -1.46, < 0.00001). Meanwhile, glucose in the LC was significantly increased in BCAA-treated patients (MD: 13.04, 95%CI: 6.81-19.89, = 0.0002).
CONCLUSION
BCAAs reduce the incidence of complications in patients with LC and ameliorate nutritional status.
背景
肝硬化（LC）目前是全球第11大常见死因和第15大发病原因。LC的治疗主要针对病因干预、生活方式干预、并发症的防治以及营养治疗。LC的营养治疗主要包括增加饮食摄入量、进食时间以及支链氨基酸（BCAAs）。尽管一些指南推荐使用BCAAs，但研究报告了其不良反应，因此BCAAs的疗效和安全性仍存在争议。目前，BCAAs已广泛应用于慢性肝病，而关于BCAAs对长期预后影响的总结却很少。
目的
确定BCAAs对LC患者的影响。
方法
检索了PubMed、Cochrane图书馆、Embase和Web of Science数据库。检索截止日期为2021年10月1日，检索未设置语言限制。该研究严格按照纳入和排除标准进行。最终纳入9项研究。主要结局是LC的并发症。次要结局是营养状况和肝功能。本荟萃分析使用Review Manager 5统计软件包（Cochrane协作网，英国牛津）进行分析。
结果
分析包括9项研究，共1080例患者（BCAA组554例，对照组526例）。这9项研究均为随机对照试验（RCT）。使用Cochrane协作网推荐的偏倚风险方法评估研究质量。BCAAs降低了LC患者的并发症发生率[风险比：0.70，95%置信区间（CI）：0.56 - 0.88，P = 0.002]，并改善了患者的白蛋白水平[标准化均数差（SMD）：0.26，95%CI：0.12 - 0.40，P = 0.0002]。同时，BCAAs显著改善了丙氨酸转氨酶水平（SMD： - 2.03，95%CI： - 2.52至 - 1.53，P < 0.00001）和天冬氨酸转氨酶水平（SMD： - 1.8，95%CI： - 2.14至 - 1.46，P < 0.00001）。同时，接受BCAA治疗的LC患者血糖显著升高（MD：13.04，95%CI：6.81 - 19.89，P = 0.0002）。
结论
BCAAs可降低LC患者的并发症发生率并改善营养状况。
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