Branched-chain amino acid enriched supplements as therapy for liver disease
Branched-chain amino acid enriched supplements as therapy for liver disease
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DOI：
10.1093/jn/136.1.295s
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发表时间：
2006-01-01
影响因子：
4.2
通讯作者：
Charlton, M
中科院分区：
文献类型：
--
作者：
Charlton, M
改变的氨基酸代谢是肝脏疾病的标志，其特征在于低水平的循环支链氨基酸和高水平的循环芳香族氨基酸和甲硫氨酸。虽然压倒性的证据表明肝病并发症的发生率随着营养不良而增加，但营养治疗，特别是BCAA补充剂对肝病患者结局的影响因适应症而异。多项小型研究报告了BCAA补充剂的有益作用，包括改善代谢特征，如通过蛋白质保留和/或呼吸系统疾病的正常化和肝性脑病的临床改善所测量的。其他研究未能显示BCAA补充剂的临床益处。关于补充支链氨基酸对预防肝硬化患者长期发病率和死亡率的影响的数据更有希望，并且已经成为2项大型随机对照试验的主题。在一项对174例晚期肝硬化患者的研究中，他们被随机分配到BCAA或2个对照组中的一个，BCAA补充组的合并事件发生率显着降低，尽管这对个体并发症并不正确。在最近的一项更大规模的随机对照试验（n = 646）中，研究人员使用更可口的配方，证明长期补充BCAA与肝衰竭频率和总体并发症频率降低相关。这两项研究都发现了与BCAA补充相关的营养状况改善。总的来说，BCAA补充剂似乎与肝硬化并发症的频率降低和维持治疗时营养状况的改善有关。成本和适口性可能会限制这种治疗方式的潜在适用性。
Altered amino acid metabolism is a hallmark of liver disease, characterized by low levels of circulating BCAAs and elevated levels of circulating aromatic amino acids, and methionine. Although overwhelming evidence indicates that the incidence of complications of liver disease increases with malnutrition, the reported impact of nutritional therapy, specifically BCAA supplementation, on outcomes in patients with liver disease has varied with the indication. Multiple small studies report the beneficial effects of BCAA supplementation, including improved metabolic profiles, as measured by protein sparing and/or normalization of respiratory quotients and clinical improvement of hepatic encephalopathy. Other studies have failed to show a clinical benefit of BCAA supplementation. The data concerning the impact of BCAA supplementation in prophylaxis of long-term morbidity and mortality in patients with cirrhosis is more promising and has been the subject of 2, large randomized controlled trials. In a study of 174 patients with advanced cirrhosis, who were randomized to either BCAA or 1 of 2 control arms, the combined event rates were seen to be significantly reduced in the BCAA supplementation arm, although this was not true for individual complications. In a more recent, larger, randomized controlled trial (n = 646) using a more palatable formulation, investigators demonstrated that long-term BCAA supplementation is associated with decreased frequency of hepatic failure and overall complication frequency. Both studies found improved nutritional status associated with BCAA supplementation. On balance, BCAA supplementation appears to be associated with decreased frequency of complications of cirrhosis and improved nutritional status when prescribed as maintenance therapy. Cost and palatability may limit the potential applicability of this treatment modality.