β-Hydroxy-β-methylbutyrate, Arginine, and Glutamine Complex on Muscle Volume Loss in Critically Ill Patients: A Randomized Control Trial
β-Hydroxy-β-methylbutyrate, Arginine, and Glutamine Complex on Muscle Volume Loss in Critically Ill Patients: A Randomized Control Trial
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DOI：
10.1002/jpen.1607
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发表时间：
2020-02-01
影响因子：
3.4
通讯作者：
Morimura, Naoto
中科院分区：
文献类型：
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作者：
Nakamura, Kensuke;Kihata, Atsushi;Morimura, Naoto
背景：β-羟基-β-甲基丁酸（HMB）是亮氨酸的代谢产物，能强烈诱导肌肉蛋白质合成。我们评估了HMB复合物对重症监护期间肌肉体积损失的疗效。方法对于这一前瞻性、单中心、随机对照试验，我们通过随机分配重症监护室（ICU）患者建立对照组和HMB组，为这些患者进行肠内营养。从164例ICU患者中，纳入并分配了88例重症患者：43例对照组和45例HMB组。HMB组从入院第2天开始，在常规营养支持的基础上，每日给予HMB 3g、精氨酸14 g、谷氨酰胺14 g。两组患者均于术后第2天开始早期肌肉电刺激康复治疗。作为主要结果，我们在第1天和第10天使用计算机断层扫描评估股肌体积。结果24名对照组和26名HMB组参与者的股肌体积按照方案进行分析。在第1-10天，E2显著降低（P < 0.0001）。对照参与者的容量损失率为14.4 +/- 7.1%，HMB参与者为11.4 +/- 8.1%（P = 0.18）。在序贯器官衰竭评估评分的亚组中，
Background beta-Hydroxy-beta-methylbutyrate (HMB), a metabolite of leucine, can strongly induce muscle protein synthesis. We evaluated the efficacy of HMB complex on muscle volume loss during critical care.Methods For this prospective, single-center, randomized control trial, we created control and HMB groups by random assignment of intensive care unit (ICU) patients for whom enteral nutrition could be performed. From 164 ICU patients, 88 severely ill patients were included and assigned: 43 to control and 45 to HMB. From day 2 after admission, HMB group were administered 3 g HMB, 14 g arginine, and 14 g glutamine daily in addition to standard nutrition therapy. Early rehabilitation with electrical muscle stimulation was started from day 2 in both groups. As a primary outcome, we evaluated femoral muscle volume using computed tomography on days 1 and 10.Results Femoral muscle volumes of 24 control and 26 HMB group participants were analyzed as per protocol. Volumes decreased significantly during days 1-10 (P < 0.0001). Volume loss rates were 14.4 +/- 7.1% for control participants and 11.4 +/- 8.1% for HMB participants (P = 0.18). In a subgroup of the sequential organ failure assessment scores