长期支链氨基酸肠内营养支持对肝硬化患者营养状况和预后影响的Meta分析

Effects of Long-Term Enteral Nutrition with Branched-Chain Amino Acids on Nutritional Status and Prognosis for Cirrhosis: A Meta-Analysis

目的系统评价长期支链氨基酸(BCAA)肠内营养支持对肝硬化患者营养状况和预后的影响。方法电子检索PubMed、EMbase、The Cochrane Library、中国知网、万方数据库、维普数据库,搜集2000年1月至2018年7月关于BCAA与任何对照干预措施治疗肝硬化的随机对照试验(RCT)研究。由两位评价员独立进行文献筛选、数据提取和偏倚风险评价,应用Stata 14.0软件进行统计分析。结果共纳入13项RCT,其中10项为高质量文献,3项为低质量文献,共1936例患者。随访期9周至6.3年。Meta分析结果显示,与对照组相比,BCAA组肝硬化患者血清白蛋白水平升高(WMD=1.49 g/L,95%CI 0.98 g/L^2.00 g/L,P<0.001),血浆氨基酸谱显著改善(SMD=0.55,95%CI 0.15~0.94,P=0.007);BCAA组上臂肌围较对照组增加(WMD=0.56 cm,95%CI 0.20 cm^0.93 cm,P=0.003),但结果不稳定;BCAA组无事件生存率显著高于对照组(HR=0.65,95%CI 0.52~0.83,P<0.001)。结论长期BCAA肠内营养支持可有效改善肝硬化患者的营养状况,特别是血清学营养指标,升高血清白蛋白水平,调整血浆氨基酸谱,并提高患者无事件生存率。

Objective To systematically evaluate the effects of long-term enteral nutrition with branched-chain amino acids(BCAA)on nutritional status and prognosis for cirrhosis.Methods Randomized controlled trial(RCT)about BCAA and any control interventions for the treatment of cirrhosis were identified through electronic searches in Databases including PubMed,EMbase,The Cochrane Library,CNKI,Wanfang Database and Vip Database from Jan.2000 to Jul.2018.Two reviewers independently conducted literature screening,data extraction and bias risk assessment,and statistical analysis was performed using Stata 14.0.Results A total of 13 RCTs involving 10 high quality studies and 3 low quality studies were included.1936 patients were followed up for 9 weeks to 6.3 years.Meta-analysis found elevated serum albumin levels(WMD=1.49 g/L,95%CI 0.98 g/L-2.00 g/L,P<0.001)and a significant improvement in plasma amino acid profile(SMD=0.55,95%CI 0.15-0.94,P=0.007)in the BCAA group compared with the control group.The middle arm muscle circumference in the BCAA group was higher than that in the control group(WMD=0.56 cm,95%CI 0.20 cm-0.93 cm,P=0.003),but the results were unstable.The event-free survival rate was significantly higher in the BCAA group than in the control group(HR=0.65,95%CI 0.52-0.83,P<0.001).Conclusion Long-term enteral nutrition with BCAA can improve the nutritional status of patients with cirrhosis,especially the serological nutritional indicators,increase serum albumin and adjust plasma amino acid profile.Furthermore,it can increase the event-free survival rate.