用于肝硬化和肝脏脑病症患者的分支链氨基酸
Luise Aamann1,2,3, Neha Deshpande4, Gitte Dam5
1The Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
The Cochrane database of systematic reviews
|January 16, 2026
概括
分支链氨基酸 (BCAA) 可能有助于减少肝脏脑病,肝脏疾病影响大脑功能. 然而,关于它们对死亡率和恶心和腹等副作用的影响的证据非常不确定.
科学领域:
- 肝病学和神经病学 肝病学和神经学
- 临床营养和胃肠道学
背景情况:
- 肝发性脑病 (HE) 是由肝功能不良或门系统性转移引起的脑功能障碍,症状从轻度到昏迷.
- 之前的元分析表明BCAA可能有利于HE,但关键结果的数据不足,需要进行更新的审查.
研究的目的:
- 评估与肝硬化和肝脏脑病患者的控制干预相比,分支链氨基酸 (BCAA) 的有益和有害影响.
主要方法:
- 进行了对18项随机临床试验 (1984-2023) 的系统审查和元分析,涉及934名明显或隐蔽肝脑病变的成年人.
- 包括的试验比较了BCAA (口服或静脉注射) 与没有干预,安慰剂,饮食,乳糖或neomycin.
- 评估结果包括所有原因的死亡率,肝脏脑病变的表现,严重的不良事件 (恶心,腹),生活质量,白蛋白和平衡,使用Cochrane方法和GRADE方法.
主要成果:
- BCAA显示出降低肝脑病变的潜力 (低确定性证据),但对全因死亡率几乎没有影响 (非常低确定性证据).
- 关于BCAA对恶心和腹的影响的证据非常不确定;与饮食对照组相比,BCAA组的发病率增加.
- 关于生活质量的数据无法进行元分析;BCAA对白蛋白或平衡没有显著影响,对这两种证据的确定性非常低.
结论:
- 目前的证据表明,BCAA可能会减少肝脏脑病变,尽管这一证据的确定性很低.
- 由于证据确定性非常低,BCAA对死亡率,不良事件,白蛋白和平衡的影响仍然不确定.
- 需要进行进一步的随机临床试验,特别是在儿童中,并将BCAA与其他已知的治疗方法比较,如不可吸收的二糖化物或rifaximin.
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