Takebayashi Katsushi, Kaida Sachiko, Otake Reiko, Fukuo Asuka, Miyake Toru, Kojima Masatsugu, Tani Soichiro, Maehira Hiromitsu, Mori Haruki, Ishikawa Hajime, Tani Masaji
Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Division of Clinical Nutrition, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae121.
The wound healing effects of a specialized amino acid supplement containing calcium beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine (HMB/Arg/Gln) have been reported. This study aimed to investigate the effectiveness of HMB/Arg/Gln in the perioperative management of patients with thoracic esophageal cancer.
This retrospective cohort study included 131 patients who underwent esophagectomy for thoracic esophageal cancer between January 2016 and November 2023. Postoperative infectious complications (PICs) were compared between patients who received HMB/Arg/Gln for 7 days before surgery (n = 95) and those who did not (control group, n = 36).
Among the 111 male and 20 female patients (median age 68 years, range 38-84 years), stage I disease was found in 37 patients, stage II in 26, stage III in 61, and stage IVa in 7. Of the 131 patients, 36 (27.5%) had PICs, with PICs occurring in 20 (21%) of the HMB/Arg/Gln group and 16 (44.4%) of the control group. The PIC rate was significantly lower in the HMB/Arg/Gln than in the control group (p = 0.007). Propensity score matching analysis showed lower rates of anastomotic leakage (5.5% vs. 22.2%; p = 0.04) and Clavien-Dindo grade III or higher PICs (5.5% vs. 27.8%; p = 0.011) in the HMB/Arg/Gln than in the control group. The healing time for anastomotic leakage was shorter in the HMB/Arg/Gln (18 days, range 7-25 days) than in the control group (25 days, range 21-56 days) (p = 0.033).
HMB/Arg/Gln supplementation was associated with reduced risk of anastomotic leakage and PIC severity following esophagectomy.
据报道，一种含有β-羟基-β-甲基丁酸钙、L-精氨酸和L-谷氨酰胺（HMB/精氨酸/谷氨酰胺）的特殊氨基酸补充剂具有伤口愈合作用。本研究旨在探讨HMB/精氨酸/谷氨酰胺在胸段食管癌患者围手术期管理中的有效性。
这项回顾性队列研究纳入了2016年1月至2023年11月期间接受胸段食管癌食管切除术的131例患者。比较术前接受7天HMB/精氨酸/谷氨酰胺治疗的患者（n = 95）和未接受治疗的患者（对照组，n = 36）的术后感染并发症（PICs）。
111例男性和20例女性患者（中位年龄68岁，范围38 - 84岁）中，37例为I期疾病，26例为II期，61例为III期，7例为IVa期。131例患者中，36例（27.5%）发生PICs，HMB/精氨酸/谷氨酰胺组20例（21%）发生PICs，对照组16例（44.4%）发生PICs。HMB/精氨酸/谷氨酰胺组的PIC发生率显著低于对照组（p = 0.007）。倾向评分匹配分析显示，HMB/精氨酸/谷氨酰胺组的吻合口漏发生率（5.5%对22.2%；p = 0.04）和Clavien-Dindo III级或更高等级的PICs发生率（5.5%对27.8%；p = 0.011）低于对照组。HMB/精氨酸/谷氨酰胺组吻合口漏的愈合时间（18天，范围7 - 25天）短于对照组（25天，范围21 - 56天）（p = 0.033）。
补充HMB/精氨酸/谷氨酰胺与降低食管切除术后吻合口漏风险和PIC严重程度相关。
