高支链氨基酸营养支持对肝脏手术患者肝功能保护作用的Meta分析  

Meta-analysis of branched chain amino acid-enriched nutrition to improve hepatic function in patients undergoing hepatic operation

作　　者：舒晓亮[1] 康凯[1] 钟静霞[2] 姬舒荣[2] 张勇胜[3] 胡怀东[4] 张大志[5] 

机构地区：[1]同济大学附属东方医院营养科, 上海,200120 [2]同济大学附属同济医院普外科 [3]广西医科大学第一附属医院营养科 [4]重庆医科大学附属第二医院营养科 [5]重庆医科大学附属第二医院感染科

出　　处：《中华肝脏病杂志》2014年第1期-,共5页Chinese Journal of Hepatology

基　　金：国家十二五科技计划课题

摘　　要：目的 系统评价添加高支链氨基酸(BCAA)的营养支持对肝脏手术患者肝功能的保护作用. 方法 检索7个生物医学数据库(包括Pubmed数据库、Springer Link数据库、中国生物医学文献数据库、Cochrane Library、中国学术期刊全文数据库等)的文献资料.按照Cochrane系统评价员手册,进行纳入随机对照研究的方法学质量评定,应用Rev Man 5.2软件进行Meta分析.结果 共纳入9项符合标准的随机对照试验相关文献(n=510).Meta分析显示:(1)研究组与对照组比较,可较好地改善术后患者的肝功能状况.研究组血浆白蛋白含量平均增加0.15 g/L,95％可信区间(CI)为0.06 ～ 0.24,P＜ 0.05;总胆红素较对照组平均降低0.07μmol/L,95％ CI为-0.18 ～ 0.05,P＞ 0.05；ALT较对照组平均增加5.61 U/L,95％ CI为-8.63 ～ 19.86,P＞0.05.(2)提供含高BCAA的营养支持可减少肝脏术后并发症的发生率,平均减少65％,95％ CI为0.48 ～ 0.87,P＜0.01.(3)卫生经济学方面,研究组住院时间较对照组平均缩短4.61 d,95％ CI为-6.61 ～-2.61],P＜0.01.结论 添加高BCAA的营养支持对肝脏手术患者肝功能具有一定的保护作用,可以较好地改善患者的肝功能,降低相关并发症的发生率,缩短患者的住院时间,从而减轻患者的经济负担,是一种较为安全有效的治疗方法,适合临床应用推广.Objective To perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.Methods The electronic databases of PubMed,Springerlink,the Chinese Biomedical Database (CBM),the Cochrane Library,and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms:nutritional support,enteral nutrition,parenteral nutrition,hepatic/liver surgery,liver cirrhosis,cancer,hepatectomy,and liver transplantation.The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration.The meta-analysis was conducted using RevMan software,version 5.2.Results A total of 11 relevant RCTs,representing 510 patients,were included in the meta-analysis.Compared to patients in the control (normal nutrition) group,the patients in the BCAA group experienced an effective improvement in hepatic function,as evidenced by significant decreases in total bilirubin (by 0.07 μmol/L; 95％ confidence interval (CI):-0.18 ～ 0.05,P ＞ 0.05].In addition,the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) =0.07; 95％ CI:0.06,0.24,P ＜ 0.05) and alanine aminotransferase (WMD =+5.61; 95％ CI:-8.63 ～ 19.86,P ＞ 0.05] but neither of the changes reached the threshold of a statistically significant improvement.The BCAA group did however show significantly lower complication rate after operation (65％,95％ CI:0.48,0.87,P ＜ 0.01] and mean duration of hospital stay (4.61 days; 95％ CI:-6.61,-2.61,P ＜ 0.01].Conclusion BCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation,thereby helping to reduce the complication risk,duration of hospital stay,and financial burden.BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

关 键 词：氨基酸类 支链 营养 肝功能 META分析 

分 类 号：R657.3[医药卫生—外科学]