支链氨基酸补充剂治疗肝硬化患者的 "肌少症"：系统回顾和元分析

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology Pub Date : 2024-09-25 DOI:10.1016/j.jceh.2024.102417

Mohamed Abuelazm , Ahmed Fares , Mahmoud M. Elhady , Ahmed Mazen Amin , Ubaid Khan , Ibrahim Gowaily , Fouad Jaber

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引用次数: 0

摘要

背景肌肉疏松症是肝硬化（LC）患者营养不良的一个重要方面，影响着 30%-70% 的肝硬化患者。鉴于支链氨基酸（BCAAs）治疗 LC 肌肉疏松症的 RCT 结果不一致，我们进行了一项系统综述和荟萃分析，以评估 BCAAs 治疗 LC 患者肌肉疏松症的有效性和安全性。我们采用固定效应模型，以风险比（RR）报告二分结果，以平均差（MD）报告连续结果，并给出95%置信区间（CI）。PROSPERO ID：CRD42024542761.结果共纳入了五项研究，434 名患者。BCAAs 与肝脏虚弱指数变化的降低有明显相关性（MD：-0.14，95% CI [-0.28，-0.01]，P = 0.03）。然而，BCAAs 和对照组在手握力变化方面没有明显差异（MD：0.98，95% CI [-0.45，2.41]，P = 0.18）。此外，BCAAs 与体重指数（BMI）变化的增加（MD：0.99，95% CI [0.16，1.82]，P = 0.02）和 QoL 的增加（标准化平均差异：0.27，95% CI [0.03，0.52]，P = 0.03）有关。然而，在终末期肝病模型（MELD）评分变化（MD：0.65，95% CI [-1.20, 2.50]，P = 0.49）、骨骼肌指数变化（MD：0.21，95% CI [-0.23, 0.65]，P = 0.35）和步速变化方面，BCAAs 组与对照组没有明显差异。结论肝硬化肌肉疏松症患者补充 BCAA 可降低肝脏虚弱指数，增加体重指数和生活质量，但不会影响手握力、骨骼肌指数、步速或 MELD 评分。研究结果存在异质性和研究偏倚，因此需要进一步开展研究性试验来证实这些结果。

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Branched-Chain Amino Acid Supplements for Sarcopenia in Liver Cirrhosis: A Systematic Review and Meta-analysis

Background

Sarcopenia, a key aspect of malnutrition in liver cirrhosis (LC), affects 30–70% of LC patients. Given the inconsistent results from RCTs on branched-chain amino acids (BCAAs) for treating sarcopenia in LC, we conducted a systematic review and meta-analysis to assess the efficacy and safety of BCAAs for sarcopenia management in LC patients.

Methods

A systematic review and meta-analysis synthesizing evidence from RCTs obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science from inception to April 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). PROSPERO ID: CRD42024542761.

Results

Five RCTs with 434 patients were included. BCAAs were significantly associated with decreased liver frailty index change (MD: −0.14 with 95% CI [-0.28, −0.01], P = 0.03). However, there was no significant difference between BCAAs and the control group regarding hand grip strength change (MD: 0.98 with 95% CI [-0.45, 2.41], P = 0.18). Also, BCAAs were associated with increased body mass index (BMI) change (MD: 0.99 with 95% CI [0.16, 1.82], P = 0.02) and increased QoL (standardized mean difference : 0.27 with 95% CI [0.03, 0.52], P = 0.03). However, there was no significant difference between BCAAs and the control group in model for end-stage liver disease (MELD) score change (MD: 0.65 with 95% CI [-1.20, 2.50], P = 0.49), skeletal muscle index change (MD: 0.21 with 95% CI [-0.23, 0.65], P = 0.35), and gait speed change (MD: 0.10 with 95% CI [-0.15, 0.34], P = 0.43).

Conclusion

BCAA supplementation in cirrhotic patients with sarcopenia reduced the liver frailty index, increased BMI and QoL, but did not affect handgrip strength, skeletal muscle index, gait speed, or MELD score. Outcome heterogeneity and study bias were noted, highlighting the need for further RCTs to confirm these results.

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来源期刊

Journal of Clinical and Experimental Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.90

自引率

16.70%

发文量

537

审稿时长

64 days