术前补充β-羟基-β-甲基丁酸、精氨酸和谷氨酰胺对心脏手术的影响：一项随机对照试验。
Effects of preoperative beta-hydroxy-beta-methylbutyrate, arginine, and glutamine supplementation on cardiac surgery: A randomized controlled trial.
作者信息
Ogawa Masato, Satomi-Kobayashi Seimi, Yoshida Naofumi, Komaki Kodai, Hirabayashi Takumi, Wakida Kumiko, Saitoh Saori, Inoue Takeshi, Yamashita Tomoya, Sakai Yoshitada, Takahashi Michiko, Okada Kenji, Hirata Ken-Ichi
机构信息
Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
出版信息
Clin Nutr. 2025 Feb;45:91-100. doi: 10.1016/j.clnu.2024.12.030. Epub 2024 Dec 31.
BACKGROUND & AIMS: In older patients undergoing cardiac surgery, physical function is a critical determinant of postoperative outcomes. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has been shown to promote muscle protein anabolism and inhibit catabolism, thereby preventing muscle weakness. However, its efficacy in older patients undergoing cardiac surgery remains unknown. This study aimed to examine the effects of preoperative HMB supplementation on postoperative physical function and complications in this population.
METHODS
In this single-center, open-label, randomized controlled trial, patients aged ≥65 years scheduled for cardiac surgery were randomized to receive HMB supplementation or no nutritional intervention. The HMB group received HMB 1200 mg, l-glutamine 7000 mg, and l-arginine 7000 mg, once or twice daily, for at least 2 weeks before surgery. Evaluations were performed at baseline and before and after surgery. The primary outcome was the 6-min walking distance (6MWD) before and after surgery. Secondary outcomes included the incidence of complications, muscle mass and strength, physical performance, and length of hospital stay.
RESULTS
Forty-four patients with a mean age of 72.5 years (women, 38 %) were randomized to the HMB (n = 22) or control (n = 22) group. Compared with the control group, the HMB group demonstrated a statistically significant improvement in the 6MWD both at the pre-surgery (448.0 ± 73.5 m vs. 375.5 ± 58.8 m; P = 0.01) and post-surgery time points (428.9 ± 76.4 m vs. 304.5 ± 52.3 m; P = 0.001). Muscle strength and physical performance also showed significant improvements in the HMB group. However, no significant difference in muscle mass was observed between the groups at any time point. The HMB group had a shorter hospital length of stay compared with that of the control group (16.1 ± 3.8 days vs. 20.4 ± 7.6 days, P = 0.03), and no adverse events were observed with the intervention.
CONCLUSIONS
Preoperative HMB supplementation in older adults undergoing cardiac surgery resulted in significant improvements in postoperative exercise capacity and physical function, along with a reduction in the length of hospital stay, without affecting muscle mass.
REGISTRATION NUMBER OF CLINICAL TRIAL
UMIN000030490 (UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773).
背景与目的
在接受心脏手术的老年患者中，身体功能是术后预后的关键决定因素。补充β-羟基-β-甲基丁酸（HMB）已被证明可促进肌肉蛋白质合成代谢并抑制分解代谢，从而预防肌肉无力。然而，其在接受心脏手术的老年患者中的疗效尚不清楚。本研究旨在探讨术前补充HMB对该人群术后身体功能和并发症的影响。
方法
在这项单中心、开放标签、随机对照试验中，计划接受心脏手术的65岁及以上患者被随机分为接受HMB补充组或无营养干预组。HMB组在手术前至少2周每天接受1200毫克HMB、7000毫克L-谷氨酰胺和7000毫克L-精氨酸，每日一次或两次。在基线以及手术前后进行评估。主要结局是手术前后的6分钟步行距离（6MWD）。次要结局包括并发症发生率、肌肉质量和力量、身体表现以及住院时间。
结果
44例平均年龄72.5岁的患者（女性占38%）被随机分为HMB组（n = 22）和对照组（n = 22）。与对照组相比，HMB组在术前（448.0±73.5米对375.5±58.8米；P = 0.01）和术后时间点（428.9±76.4米对304.5±52.3米；P = 0.001）的6MWD均有统计学显著改善。HMB组的肌肉力量和身体表现也有显著改善。然而，在任何时间点两组之间的肌肉质量均未观察到显著差异。与对照组相比，HMB组的住院时间更短（16.1±3.8天对20.4±7.6天，P = 0.03），且干预未观察到不良事件。
结论
在接受心脏手术的老年人中，术前补充HMB可使术后运动能力和身体功能显著改善，同时缩短住院时间，且不影响肌肉质量。
临床试验注册号
UMIN000030490（UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773）
Zotero 插件