支链氨基酸补充剂用于肝硬化患者肌肉减少症的系统评价和荟萃分析
Branched-Chain Amino Acid Supplements for Sarcopenia in Liver Cirrhosis: A Systematic Review and Meta-analysis.
作者信息
Abuelazm Mohamed, Fares Ahmed, Elhady Mahmoud M, Amin Ahmed Mazen, Khan Ubaid, Gowaily Ibrahim, Jaber Fouad
机构信息
Faculty of Medicine, Tanta University, Tanta, Egypt.
Internal Medicine Department, Tufts Medical Center, Boston, USA.
出版信息
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102417. doi: 10.1016/j.jceh.2024.102417. Epub 2024 Sep 25.
BACKGROUND
Sarcopenia, a key aspect of malnutrition in liver cirrhosis (LC), affects 30-70% of LC patients. Given the inconsistent results from RCTs on branched-chain amino acids (BCAAs) for treating sarcopenia in LC, we conducted a systematic review and meta-analysis to assess the efficacy and safety of BCAAs for sarcopenia management in LC patients.
METHODS
A systematic review and meta-analysis synthesizing evidence from RCTs obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science from inception to April 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). PROSPERO ID: CRD42024542761.
RESULTS
Five RCTs with 434 patients were included. BCAAs were significantly associated with decreased liver frailty index change (MD: -0.14 with 95% CI [-0.28, -0.01], = 0.03). However, there was no significant difference between BCAAs and the control group regarding hand grip strength change (MD: 0.98 with 95% CI [-0.45, 2.41], = 0.18). Also, BCAAs were associated with increased body mass index (BMI) change (MD: 0.99 with 95% CI [0.16, 1.82], = 0.02) and increased QoL (standardized mean difference : 0.27 with 95% CI [0.03, 0.52], = 0.03). However, there was no significant difference between BCAAs and the control group in model for end-stage liver disease (MELD) score change (MD: 0.65 with 95% CI [-1.20, 2.50], = 0.49), skeletal muscle index change (MD: 0.21 with 95% CI [-0.23, 0.65], = 0.35), and gait speed change (MD: 0.10 with 95% CI [-0.15, 0.34], = 0.43).
CONCLUSION
BCAA supplementation in cirrhotic patients with sarcopenia reduced the liver frailty index, increased BMI and QoL, but did not affect handgrip strength, skeletal muscle index, gait speed, or MELD score. Outcome heterogeneity and study bias were noted, highlighting the need for further RCTs to confirm these results.
背景
肌肉减少症是肝硬化（LC）营养不良的一个关键方面，影响30%-70%的LC患者。鉴于随机对照试验（RCT）关于支链氨基酸（BCAAs）治疗LC患者肌肉减少症的结果不一致，我们进行了一项系统评价和荟萃分析，以评估BCAAs治疗LC患者肌肉减少症的疗效和安全性。
方法
进行一项系统评价和荟萃分析，综合从创刊至2024年4月在PubMed、Embase、Cochrane、Scopus和Web of Science上获取的RCT证据。我们使用固定效应模型报告二分结果的风险比（RR）和连续结果的平均差（MD），并给出95%置信区间（CI）。国际前瞻性系统评价注册编号：CRD42024542761。
结果
纳入了5项RCT，共434例患者。BCAAs与肝脏衰弱指数变化降低显著相关（MD：-0.14，95%CI[-0.28，-0.01]，P=0.03）。然而，BCAAs与对照组在握力变化方面无显著差异（MD：0.98，95%CI[-0.45，2.41]，P=0.18）。此外，BCAAs与体重指数（BMI）变化增加相关（MD：0.99，95%CI[0.16，1.82]，P=0.02）以及生活质量（QoL）提高相关（标准化平均差：0.27，95%CI[0.03，0.52]，P=0.03）。然而，BCAAs与对照组在终末期肝病模型（MELD）评分变化（MD：0.65，95%CI[-1.20，2.50]，P=0.49）、骨骼肌指数变化（MD：0.21，95%CI[-0.23，0.65]，P=0.35）和步速变化（MD：0.10，95%CI[-0.15，0.34]，P=0.43）方面无显著差异。
结论
在伴有肌肉减少症的肝硬化患者中补充BCAAs可降低肝脏衰弱指数，增加BMI和QoL，但不影响握力、骨骼肌指数、步速或MELD评分。注意到结果的异质性和研究偏倚，强调需要进一步的RCT来证实这些结果。
Zotero 插件