长期口服支链氨基酸改善肝硬化预后及其安全性的Meta分析  

Prognosis and safety of long-term oral branched-chain amino acids for cirrhosis： a meta-analysis

作　　者：吕彩霞[1] 刘春亮[2] 王琦[2] 

机构地区：[1]山西医科大学研究生院,太原030001 [2]山西医科大学第二医院消化内科

出　　处：《中华临床营养杂志》2014年第4期219-224,共6页Chinese Journal of Clinical Nutrition

摘　　要：目的 评价长期口服支链氨基酸改善肝硬化预后及其安全性.方法 计算机检索PubMed、CNKI等多个中英文数据库,收集以口服支链氨基酸（BCAAs）为干预措施治疗肝硬化的随机对照试验（RCT）,按照Cochrane系统评价方法,由两位研究者独立地对符合纳入标准的试验进行资料提取,并对纳入文献进行质量评价和对提取的有效数据进行Meta分析.结果 有6个RCT,共计1 047例肝硬化患者符合纳入标准.Meta分析结果显示口服BCAAs组的无事件生存率略高于对照组[RR=1.13,95％ CI=（1.05,1.23）,P=0.001],不能降低肝硬化患者的病死率（P=0.40）.BCAAs对于降低轻微肝性脑病患者的恶化率及改善生命质量没有明确结果.口服BCAAs组有患者发生以消化道症状为主的不良反应.结论 长期口服BCAAs对肝硬化患者无事件生存率有一定的提高,但由于缺乏更多大样本量、高质量的RCT证据支持,尚不能做出最后结论.Objective To evaluate the prognosis and safety of long-term oral Branched-Chain Amino Acids （BCAAs） for patients with cirrhosis.Methods Randomized controlled trials （RCTs） were identified from CBM （between January 1978 and September 2013）,CNKI （between January 1979 and September 2013）,PubMed （between January 1970 and September 2013）,EMBASE （between January 1970 and September 2013）,and Cochrane Library （issue 4,2013）.Publications of the RCTs on the treatment of cirrhosis with oral BCAAS were included and analyzed according to the criteria of Cocbrane handbook.Results Six RCTs involving 1 047 patients were included.The results showed that oral BCAAs improved the event-free survival when compared with the control group [RR =1.13,95% CI =（1.05,1.23）,P =0.001].BCAAs supplements had no effect on mortality or had no definite effect on the deteriorative rate of minimal hepatic encephalopathy （MHE） or quality of life （QOL）.As reported in some trials,the main side effects of BCAAs were gastrointestinal symptoms.Conclusions Long-term oral BCAAs may improve event-free survival in cirrhotic patients.However,no definite conclusion can be made without evidences from larger,randomized,double-blind,placebo-controlled,and multicenter trials.

关 键 词：支链氨基酸 肝硬化 轻微肝性脑病 随机对照试验 META分析 

分 类 号：R575.2[医药卫生—消化系统]