Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands.
Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Eur J Clin Invest. 2023 Mar;53(3):e13909. doi: 10.1111/eci.13909. Epub 2022 Dec 8.
Dietary supplementation with branched-chain amino acids (BCAA) is often used in cirrhotic patients to improve nutritional status. We wanted to explore the evidence for BCAA supplementation in chronic liver disease.
We searched MEDLINE and EMBASE for studies with BCAA supplementation with the presence of a disease-control group (placebo or no intervention) using search terms 'liver cirrhosis', 'hepatocellular carcinoma', 'branched chain amino acids' and relevant synonyms. Risk of bias was assessed using ROBINS-I and RoB 2.0 tools. Meta-analyses were performed with a random-effects model. Results were reported following EQUATOR guidelines.
Of 3378 studies screened by title and abstract, 54 were included (34 randomized controlled trials, 5 prospective case-control studies, 13 retrospective case-control studies: in total 2308 patients BCAA supplementation, 2876 disease-controls). Risk of bias was high/serious for almost all studies. According to meta-analyses, long-term (at least 6 months) BCAA supplementation in cirrhotic patients significantly improved event-free survival (p = .008; RR .61 95% CI .42-.88) and tended to improve overall survival (p = .05; RR .58 95% CI .34-1.00). Two retrospective studies suggested the beneficial effects during sorafenib for hepatocellular carcinoma. Available studies reported no beneficial effects or contradictory results of BCAA after other specific therapeutic interventions (resection or radiological interventions for hepatocellular carcinoma, liver transplantation, paracentesis or variceal ligation). No convincing beneficial effects of BCAA supplementation on liver function, nutritional status or quality of life were found. No study reported serious side effects of BCAA.
Prophylactic BCAA supplementation appears safe and might improve survival in cirrhotic patients.
在肝硬化患者中，经常使用支链氨基酸（BCAA）的饮食补充剂来改善营养状况。我们想探讨 BCAA 补充剂在慢性肝病中的应用证据。
我们使用“liver cirrhosis”、“hepatocellular carcinoma”、“branched chain amino acids”和相关同义词等搜索词，在 MEDLINE 和 EMBASE 中搜索了有疾病对照组（安慰剂或无干预）的 BCAA 补充剂研究。使用 ROBINS-I 和 RoB 2.0 工具评估偏倚风险。使用随机效应模型进行荟萃分析。结果按照 EQUATOR 指南报告。
通过标题和摘要筛选出 3378 项研究，其中 54 项符合纳入标准（34 项随机对照试验、5 项前瞻性病例对照研究、13 项回顾性病例对照研究：共 2308 例患者接受 BCAA 补充剂，2876 例疾病对照）。几乎所有研究的偏倚风险都很高/严重。根据荟萃分析，肝硬化患者长期（至少 6 个月）补充 BCAA 可显著改善无事件生存（p=0.008；RR 0.61，95%CI 0.42-0.88），且倾向于改善总生存（p=0.05；RR 0.58，95%CI 0.34-1.00）。两项回顾性研究表明，BCAA 在索拉非尼治疗肝细胞癌时具有有益作用。现有研究报告称，BCAA 对其他特定治疗干预（肝细胞癌切除术或放射干预、肝移植、腹腔穿刺术或静脉曲张结扎术）后无有益作用或结果相反。未发现 BCAA 补充剂对肝功能、营养状况或生活质量有明显的有益作用。没有研究报告 BCAA 补充剂有严重的副作用。
预防性 BCAA 补充剂似乎安全，并可能改善肝硬化患者的生存。
