高支链氨基酸饮食对乙型肝炎肝硬化患者营养状态及预后的影响  

Influence of enriched branched-chain amino acid diet on nutrition condition and prognosis in patients with hepatitis B cirrhosis

作　　者：袁伟[1] 张宇一[1] 张正国[1] 邹颖[1] 王介非[1] 钱志平[1] 

机构地区：[1]上海市公共卫生临床中心重症肝病&ICU科,201508

出　　处：《肝脏》2014年第5期307-310,共4页Chinese Hepatology

摘　　要：目的探讨高支链氨基酸(BCAA)对乙型肝炎肝硬化患者营养状态及长期预后的影响。方法选取肝硬化患者92例,随机分为高BCAA治疗组47例,对照组45例。所有患者均参照2006年欧洲肠内肠外营养学会肝病肠内营养指南推荐给予营养支持治疗。治疗组给予富含BCAA制剂替代50%的氨基酸摄入量,对照组给予相同比例的整蛋白全营养素。分别于12周和48周测定患者的上臂肌围(AMC),检测总蛋白(TP)、前白蛋白(PA)、白蛋白(Alb)及凝血酶原活动度(PTA),并随访至96周,观察随访期内两组肝硬化相关并发症的发生情况并分析患者预后。组内比较采用配对样本t检验,组间比较采用独立样本t检验和χ2检验。结果第12周时,治疗组Child-Pugh评分较对照组有所改善(7.70±1.65比7.38±1.72,t=3.591,P<0.05)。第48周时,治疗组患者的AMC[(24.76±1.04)cm比(24.02±1.64)cm,t=-2.297,P<0.05]、TP[(63.01±3.62)g/L比(59.39±4.05)g/L,t=-4.004,P<0.01]、PA[(123.68±34.45)mg/L比(97.03±28.60)mg/L,t=-3.611,P<0.05]和Alb[(34.05±3.13)g/L比(32.44±3.53)g/L,t=-2.057,P<0.05]均高于对照组;与对照组相比,治疗组PTA有明显改善[(99.70±9.07)%比(87.75±20.95)%,t=-3.109,P<0.01]。随访至96周时,治疗组肝性脑病和感染的发生率较对照组显著减少(χ2=3.921,P<0.05;χ2=4.458,P<0.05),而肝肾综合征和消化道出血两组比较差异无统计学意义;治疗组病死率为6.38%,对照组病死率为17.78%,在非移植存活率的比较上两组间差异具有统计学意义(P<0.05)。结论高BCAA能有效改善患者营养及肝功能情况,改善患者的中远期预后。Objective To observe the influence of enriched branched-chain amino acid on nutrition condition,liver function and prognosis in patients with hepatitis B cirrhosis.Methods Ninety-two patients with liver cirrhosis were enrolled.The patients were randomly divided into two groups,including 47 cases treated with branched-chain amino acid in treatment group and 45 cases treated with regular dieteric treatment in control group.Evaluations of liver function and nutrition condition were followed up to the 96th week in both groups,as well as observations of incidence of cirrhosis related complications.Results Compared to pre-treatment,Child-Pugh score（7.70±1 .65 vs.7.38±1 .72,t=3.591 , P 〈0.05）intreatment group was obviously promoted at week 12;Compared to control group at week 48,arm muscle circumference[（24.76±1 .04）cm vs.（24.02±1 .64）cm,t=-2.297,P 〈0.05],total protein [（63.01 ±3.62 g/L vs. （59.39±4.05 ）g/L,t = -4.004,P 〈 0.01 ],pre-albumin [（123.68 ±34.45 ）mg/L vs.（97.03 ±28.60 ）mg/L,t =-3.611 ,P 〈0.05],albumin[（34.05±3.13）g/L vs.（32.44±3.53）g/L,t=-2.057,P 〈0.05]and prothrombin time activity [（99.70±9.07）% vs.（87.75 ±20.95 ）%,t = -3.109,P 〈0.01 ]were significantly increased in treatment group.During a follow-up 96 weeks,incidences of hepatic encephalopathy and infection in treatment group lower than those in control group （χ2 =3.921 ,P 〈0.05;χ2 =4.458 P 〈0.05）.There was no significant difference in incidences of hepatorenal syndrome and hemorrhage of digestive tract between two groups.Furthermore,control group showed a poor prognosis （P 〈0.05）.Conclusion Enriched branched-chain amino acid can improve nutrition condition,liver function and prognosis in patients with liver cirrhosis.

关 键 词：高支链氨基酸 乙型肝炎 肝硬化 预后 

分 类 号：R575.2[医药卫生—消化系统]