Effect of administration of β-hydroxy-β-methyl butyrate?enriched formula after liver transplantation: A pilot randomized controlled trial
Effect of administration of β-hydroxy-β-methyl butyrate?enriched formula after liver transplantation: A pilot randomized controlled trial
复制标题
肝移植后服用富含β-羟基-β-甲基丁酸酯的配方的效果：一项随机对照试验
DOI：
10.1016/j.nut.2020.110871
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发表时间：
2020
期刊：
影响因子：
4.4
通讯作者：
Uemoto Shinji
中科院分区：
文献类型：
--
作者：
Kamo Naoko;Kaido Toshimi;Uozumi Ryuji;Ito Takashi;Yagi Shintaro;Hata Koichiro;Taura Kojiro;Uemoto Shinji
目的大多数接受肝移植（LT）的患者骨骼肌质量下降，营养不良，体力活动水平下降。这些合并症可能妨碍术后早期恢复。本研究的目的是研究口服营养配方丰富的β-羟基-β-甲基丁酸盐（HMB）（一种促进肌肉合成和抑制蛋白质水解的亮氨酸代谢物）对成人对成人活体移植（LDLT）术后肌肉减少症和其他结局的影响。方法将2017年3月至2018年10月期间连续33例符合纳入标准的成人LDLT患者按1:1的比例随机分配到HMB组或对照组。HMB组患者术后第1天至术后第30天，每天给予2包富含HMB的营养素，每包含钙-HMB （1500 mg）、l-精氨酸（7000 mg）和l-谷氨酰胺（7000 mg），口服或肠内服用。主要终点是LDLT后2个月的握力（GS）。次要终点包括LDLT后1个月的GS、LDLT后1个月和2个月的骨骼肌质量指数（SMI）、实验室结果、术后菌血症发生率和术后住院时间（LOS）。结果HMB组12例，对照组11例纳入最终分析。HMB组1、2个月时的GS值和2个月时的SMI值均显著高于对照组（GS: P< 0.001, SMI:P= 0.04）。与对照组相比，HMB组LDLT术后3周白细胞计数明显降低（P= 0.005），术后住院时间明显缩短（P= 0.028）。HMB组术后菌血症发生率较低。结论术后给予hmb浓缩方配合康复治疗可显著提高LDLT术后1、2个月的GS和2个月的SMI，缩短LDLT术后医院LOS。
ObjectiveMost patients undergoing liver transplantation (LT) have decreased skeletal muscle mass, malnutrition, and decreased physical activity levels. These comorbidities may prevent early recovery after surgery. The aim of this study was to examine the effects of oral nutritional formula-enriched β-hydroxy-β-methyl-butyrate (HMB), a leucine metabolite that promotes muscle synthesis and suppresses proteolysis, on postoperative sarcopenia and other outcomes after adult-to-adult living donor LT (LDLT).MethodsThirty-three consecutive patients who underwent adult LDLT between March 2017 and October 2018 and who met inclusion criteria were randomly assigned in a 1:1 ratio to the HMB or control group. Patients in the HMB group received two packs of HMB-rich nutrients per day, which contained calcium-HMB (1500 mg),l-arginine (7000 mg), andl-glutamine (7000 mg) per pack orally or enterally from postoperative day 1 to 30 with postoperative rehabilitation. The primary endpoint was grip strength (GS) at 2 mo after LDLT. Secondary endpoints included GS at 1 mo after LDLT, skeletal muscle mass index (SMI) at 1 and 2 mo after LDLT, laboratory findings, incidence of postoperative bacteremia, and postoperative hospital length of stay (LOS).ResultsTwelve patients in the HMB group and 11 in the control group were included in the final analysis. GS at 1 and 2 mo and SMI values at 2 mo were significantly higher in the HMB group than in the control group (GS: bothP< 0.001, SMI:P= 0.04). In the HMB group, white blood cell count 3 wk after LDLT was significantly lower (P= 0.005), and postoperative hospital LOS was significantly shorter (P= 0.028) compared with the control group. The incidence of postoperative bacteremia was lower in the HMB group.ConclusionsPostoperative administration of HMB-enriched formula with rehabilitation significantly increased GS at 1 and 2 mo and SMI at 2 mo and shortened postoperative hospital LOS after LDLT.