静脉注射BCAA输液不会导致ACLF - 一个开放标签随机临床试验中的开放HE的持续恢复
Rohit Mehtani1, Madhumita Premkumar1, Shankey Garg2
1Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Journal of clinical and experimental hepatology
|November 17, 2023
概括
静脉注射分支链氨基酸 (IV-BCAA) 与乳糖在急性至慢性肝衰竭 (ACLF) 患者的肝脑病变 (HE) 呈现出快速但不持续的改善. 这种治疗没有改善28天的整体存活率.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 临床营养学 临床营养学
背景情况:
- 肝脑病变 (HE) 在急性-慢性肝衰竭 (ACLF) 中显著增加了发病率和死亡率.
- 在ACLF中有效的HE治疗对于改善患者的治疗结果至关重要.
- 了解像IV-BCAA这样的特定营养干预措施的作用很重要.
研究的目的:
- 评估静脉注射分支链氨基酸 (IV-BCAA) 与乳糖相结合的疗效与单独的乳糖对改善ACLF患者的HE.
- 评估IV-BCAA在24小时,3日和7日对HE等级的影响.
- 为了确定对整体存活率和重症监护室 (ICU) 停留的影响.
主要方法:
- 进行了一项前性随机对照试验,涉及欧洲肝脏研究协会 (EASL) 定义的ACLF患者.
- 患者被随机分为两个组:IV-BCAA (500毫升/天3天) 加乳糖,或仅含乳糖.
- 主要结局是HE至少提高一个等级,使用肝脑病得分算法 (HESA) 评估,在72小时后.
主要成果:
- 在70名分析患者中,IV-BCAA和对照组之间的基线特征相似.
- 在IV-BCAA手臂 (40%) 与对照组 (17.1%) (P=0.03) 相比,在24小时后HESA显著改善≥1级.
- 这种HE的改善在第3天或第7天没有持续,并且没有发现28天整体存活率 (48.5%与31.4%;P=0.14) 的显著差异.
结论:
- 静脉注射BCAA治疗不会导致ACLF患者的HE等级持续改善.
- 虽然IV-BCAA可能在HE管理中提供短期益处,但它不会影响长期生存.
- 需要进一步的研究,以探索ACLF中HE的持续治疗策略.
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