Essential amino acid supplementation in patients following total knee arthroplasty
Essential amino acid supplementation in patients following total knee arthroplasty
复制标题
DOI：
10.1172/jci70160
复制
发表时间：
2013-11-01
影响因子：
15.9
通讯作者：
Jewett, Brian A.
中科院分区：
文献类型：
--
作者：
Dreyer, Hans C.;Strycker, Lisa A.;Jewett, Brian A.
背景到2030年，预计将有348万美国老年人接受全膝关节置换术（TKA）。在这种手术之后，会发生相当大的肌肉萎缩，导致力量下降和功能活动性受损。必需氨基酸（EAA）已被证明可以在活动减少期间减轻肌肉损失，并可能对TKA患者有益。我们对28名接受全膝关节置换术的老年人进行了一项双盲、安慰剂对照、随机临床试验。患者随机接受20 g EAA（n = 16）或安慰剂（n = 12），每日两次，在TKA前1周和TKA后2周的两餐之间。在基线、TKA后2周和6周，进行MRI以确定大腿中部肌肉和脂肪组织体积。同时测量肌肉力量和功能活动度。接受安慰剂的TKA患者表现出更大的股四头肌萎缩，从基线到术后2周的变化为-14.3 +/- 3.6%，而EAA组为-3.4 +/- 3.1%（F = 5.16，P = 0.036），安慰剂组从基线到术后6周的变化为-18.4 +/- 2.3%，EAA组为-6.2 +/- 2.2%（F = 14.14，P = 0.001）。EAAs也减弱了非手术的股四头肌和两肢的腘绳肌和内收肌的萎缩。术后2周和6周功能活动度测试，EAA组优于对照组（均P < 0.05）。股四头肌萎缩程度的改变与功能活动度的改变显著相关（F = 5.78，P = 0.021）。EAA治疗减轻了TKA后老年人的肌肉萎缩，并加速了功能性活动的恢复。
Background. By the year 2030, 3.48 million older U.S. adults are projected to undergo total knee arthroplasty (TKA). Following this surgery, considerable muscle atrophy occurs, resulting in decreased strength and impaired functional mobility. Essential amino acids (EAAs) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients.Methods. We used a double-blind, placebo-controlled, randomized clinical trial with 28 older adults undergoing TKA. Patients were randomized to ingest either 20 g of EAAs = 16) or placebo (n = 12) twice daily between meals for 1 week before and 2 weeks after TKA. At baseline, 2 weeks, and 6 weeks after TKA, an MRI was performed to determine mid-thigh muscle and adipose tissue volume. Muscle strength and functional mobility were also measured at these times.Results. TKA patients receiving placebo exhibited greater quadriceps muscle atrophy, with a -14.3 +/- 3.6% change from baseline to 2 weeks after surgery compared with -3.4 +/- 3.1% for the EAA group (F = 5.16, P = 0.036) and a -18.4 +/- 2.3% change from baseline to 6 weeks after surgery for placebo versus -6.2 +/- 2.2% for the EAA group (F = 14.14, P = 0.001). EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities. The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests (all P < 0.05). Change in quadriceps muscle atrophy was significantly associated with change in functional mobility (F = 5.78, P = 0.021).Conclusion. EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA.