复方支链氨基酸颗粒剂治疗肝硬化低蛋白血症多中心临床观察

目的 观察口服复方支链氨基酸颗粒剂（商品名力维特,Livact)对肝硬化低蛋白血症的疗效和安全性。方法 上海地区6家医院共选择有低蛋白血症的肝硬化患者172例,其中治疗组120例,对照组52例,分别给予复方支链氨基酸颗粒剂和对照组药物复合氨基酸胶囊,治疗4周和9周后观察其临床太,血清总蛋白和白蛋白及Fisher比值的变化,评估其有效性和安全性。结果 复方支链氨基酸颗粒剂治疗组和对照组各项症状在治疗后均有显著改善（P＜0．05）,其中复方支链氨基酸颗粒剂对疲劳感的改善情况优于对照组（P＝0．03）。复方支链氨基酸颗粒剂组在治疗4周和9周后,血清总蛋白和白蛋白均显著升高（P均为0．0001）,Fisher比值复方支链氨基酸颗粒剂组治疗4周和9周后较前有显著改变（P分别为0．0005和0．0001）,对照组则无明显变化（P＝0．75）。治疗过程中,复方支链氨基酸颗粒剂组和对照组的不良反应发生率为分别为7．50％和3．85％,程度均较轻。结论 复方支链氨基酸颗粒剂是治疗肝硬化低蛋白血症有效而安全的药物。     

口服支链氨基酸制剂对肝硬化低蛋白血症糖代谢影响的研究

肝硬化患者60％～80％伴有糖耐量异常,至少10％～15％的肝硬化患者同时患有糖尿病。肝硬化时,患者应用口服支链氨基酸会对其机体糖代谢及胰岛素抵抗产生何种影响,对这一问题的深入研究,有助于指导临床进行综合营养支持治疗。为此,我们进行了一项前瞻性、随机、开放的临床研究,以血糖、生长激素、胰岛素水平变化为监测指标,初步探讨口服支链氨基酸制剂对肝硬化胰岛素抵抗及相关因素的影响。     

增强支链氨基酸氧化代谢改善心力衰竭患者心功能

心力衰竭(HF)是指由于心脏的收缩功能和(或)舒张功能发生障碍,不能将静脉回心血量充分排出心脏,导致静脉系统血液淤积,动脉系统血液灌注不足,从而引起心脏循环障碍的临床综合征,此种心脏综合征会引起循环肺淤血、体循环淤血和组织血液灌注不足。HF的病理生理机制一直是研究的重点,旨在寻找更有效的预防和治疗手段。支链氨基酸是重要的必需氨基酸,其与心血管疾病的相关性研究越来越多。本文主要针对支链氨基酸代谢与HF的研究进展作一综述。     

支链氨基酸代谢机制研究进展

支链氨基酸是人体营养必需氨基酸。它们不仅是蛋白质的基本构成单位,而且作为调节糖脂代谢、细胞凋亡和自噬的信号分子发挥着重要的生理功能。除了合成代谢外,分解代谢在支链氨基酸代谢中也同样发挥着重要作用。支链氨基酸代谢异常与胰岛素抵抗、糖尿病、动脉粥样硬化、肿瘤等疾病的进展密切相关。然而其代谢机制并不十分清楚,本文现将支链氨基酸的代谢途径及各器官的分解代谢特点作一综述。     

支链氨基酸与心血管疾病的研究进展

支链氨基酸是哺乳动物体内的重要营养物质,支链氨基酸代谢稳态对心功能的维持至关重要,同时参与多种疾病的发生发展过程。近年来也有越来越多的研究表明,支链氨基酸的代谢异常和心血管疾病及多种代谢性疾病有着紧密的联系。现对支链氨基酸代谢过程进行概述,就其在心力衰竭、急性心肌梗死、心肌缺血再灌注损伤、心律失常、糖尿病心肌病、高血压等心血管疾病中的研究进展进行综述,并对未来研究方向予以展望。     

不同透析膜进行血液透析对血浆支链氨基酸和芳香氨基酸的影响

支链氨基酸（ＢＣＡＡ）和芳香氨基酸（ＡＡＡ）在体内存在一定含量和比例。它们在通过血脑屏障时具有竞争性。ＢＣＡＡ减少或者ＢＣＡＡ与ＡＡＡ比例失调不仅影响机体蛋白质的代谢，还可引起神经系统功能的变化。我们旨在研究应用不同透析膜对病人进行透析时，血浆ＢＣＡ...     

肝硬化患者支链氨基酸的应用进展

氨基酸主要在肝脏代谢,肝硬化患者的蛋白质、糖类、脂肪代谢紊乱,体内氨基酸代谢失衡,继而引起全身多脏器、多系统的功能不全,出现肝性脑病、食管静脉曲张破裂出血、腹水等并发症,导致较高的病死率。总结了肝硬化患者氨基酸代谢特点及支链氨基酸在肝硬化治疗中的应用,指出支链氨基酸制剂在调整肝病患者的血清氨基酸谱,升高支链氨基酸与芳香族氨基酸的比值,预防肝硬化并发症,提高肝硬化患者生活质量方面具有重要作用。     

老年人低蛋白血症研究进展

低蛋白血症在临床上较为常见,老年人是其高发人群,与老年人所患疾病的发生、发展及预后关系密切;正确认识、及时防治老年人低蛋白血症可使老年患者获益。现结合国内外文献,就老年人低蛋白血症的原因、危害、防治及其进展做一综述。     

急慢性肝性脑病病人中支链氨基酸的应用

肝性脑病(Hepatic encephalopathy,HE)是急性肝衰竭或慢性实质性肝病时伴随出现的精神神经综合征。关于其发病原因的最新理论为芳香氨基酸和假性神经递质的理论。1957年Uber 等报告,在肝功能衰竭病人血清中,芳香氨基酸(AAA,主要是苯丙氨酸、色氨酸和酪氨酸)增高,而支链氨基酸(BCAA,主要是缬氨酸、亮氨酸和异亮氨酸)降低,由于非     

Effect of an oral branched chain amino acid‐enriched snack in cirrhotic patients with sleep disturbance

Aim: Sleep is closely related to physical and mental health. Sleep disturbance is reported in patients without encephalopathy. We examined the relationship among cirrhotic symptoms, laboratory data and sleep disturbances. Next, we examined the influence of a branched chain amino acid (BCAA) supplement on sleep disturbance in cirrhotic patients. Methods: We investigated a total of 21 patients at Nagasaki University Hospital from January to June 2009. We constructed questionnaire items for the evaluation of cirrhotic symptoms. The items, as major symptoms of cirrhotic patients, were as follows: hand tremor, appetite loss, muscle cramp of foot, fatigue, decreased strength, anxiety, abdominal fullness, abdominal pain and a feeling of low energy. We used the Epworth Sleepiness Scale (ESS) for the evaluation of daytime hypersomnolence. Energy supplementation with a BCAA snack was performed as a late evening snack (LES). All patients were assessed at the time of entry into the study, and at 4 and 8 weeks. Results: It was found that BCAA snack, taken p.o. as an LES, improved the ESS for cirrhotic patients without encephalopathy. This beneficial result was recognized in the short term, 4 weeks after beginning of treatment. This study demonstrated the utility of BCAA supplementation for cirrhotic patients with sleep disturbance. However, the cirrhotic symptom‐related score was positively relation with the Child–Pugh score at the time of patient entry, and we were unable to identify the item that related to ESS. Conclusion: A BCAA snack is a useful drug for cirrhotic patients who do not have any overt encephalopathy, but who suffered from sleep disturbance.     

Anti-hypoalbuminemic effect of branched-chain amino acid granules in patients with liver cirrhosis is independent of dietary energy and protein intake

Aim: A multicenter prospective intervention study was conducted in 204 patients with uncompensated liver cirrhosis to explore the influence of dietary intake and patient clinical characteristics on improvement of hypoalbuminemia at weeks 12 and 24 of treatment with branched-chain amino acid (BCAA) granules. Methods: The primary endpoint set in this study was improvement of hypoalbuminemia in patients with liver cirrhosis. The dietary energy and protein intake per day were estimated based on the results of a survey on diet during a 3-day period preceding the start of the study. Results: As for the primary endpoint, the mean serum albumin level increased significantly at weeks 12 and 24 of BCAA treatment, compared with the baseline level. The mean Child-Pugh score decreased significantly at weeks 12 and 24 of treatment as compared to the mean baseline score. There was a significant increase in the serum albumin level following treatment with BCAA granules regardless of energy intake and of protein intake. The incidence of ascites and edema significantly decreased in the overall patient population both at weeks 12 and 24 of treatment, compared with the baseline incidence. A subgroup analysis conducted in patients stratified according to changes in the serum albumin level at week 12 of treatment as against baseline showed that the incidence of ascites/edema was significantly reduced not only in the increased albumin group but in the unchanged albumin group. Conclusion: The present data suggest that the anti-hypoalbuminemic effect of BCAA treatment in patients with liver cirrhosis is independent of dietary intake.     

Influence of glutamine and branched chain amino acids on the jejunal atrophy associated with parenteral nutrition

Infusions of conventional parenteral nutrients (CPN) are associated with gut atrophy. This may be due to the absence of glutamine in such solutions. Although glutamine is a preferred gut nutrient, it is excluded from CPN because it is unstable at room temperature. This problem may be circumvented either directly by the infusion of fresh solutions of glutamine, or indirectly by the infusion of branched chain amino acids (BCAA). We evaluated the effect of infusing either glutamine, BCAA, or glutamine plus BCAA-enriched CPN on the rat jejunum. Sixty male Wistar rats were randomized to receive 6 days of either conventional parenteral nutrition (CPN), CPN plus 1.5% glutamine (GLN), CPN plus 2% BCAA (BCAA), CPN plus 0.8% BCAA and 1.0% glutamine (GLN/BCAA), or a normal oral diet (Chow). Standardized segments of jejunum were then removed for assessment. Compared with the CPN group, both the GLN/BCAA and the BCAA groups had greater mucosal weights (P less than 0.05) and mucosal protein concentrations (P less than 0.05), the GLN/BCAA group had greater jejunal weights (P less than 0.05), and the GLN group had an increased jejunal weight (P less than 0.05) and a higher crypt cell production rate (P less than 0.05). We conclude that the infusion of glutamine or BCAA-enriched parenteral nutrition improves jejunal morphology compared with conventional parenteral nutrition.     

支链氨基酸对脓毒性脑病神经元特异性烯醇化酶含量的影响

目的:脓毒性脑病（SAE）的治疗效果并不理想,探索新颖的治疗策略非常需要。支链氨基酸对SAE的治疗效果还存在争议,本文探究支链氨基酸（BCAAs）是否可以通过下调神经元特异性烯醇化酶（NSE）含量,从而在治疗SAE时,达到有更好的治疗效果。 方法:本文将本院ICU病房收诊的SAE患者随机地分成2组,分别是BCAAs治疗组（n=40）与常规治疗组（n=42）进行实验,常规治疗组是通过接受SAE指南指导的综合策略进行干预,BCAAs治疗组的治疗策略是常规组策略加上BCAAs进行干预。结果:2组患者的基线资料,性别比例,年龄,急性生理和慢性健康评分II,GCS评分统计学上无显著差异,基线资料基本一致,可以进行实验比较。我们对患者神经精神状况做了GCS评分,在治疗策略干预14天后,2组评分得分均有显著恢复,BCAAs组GCS评分得分在统计学差异上明显高于常规组;2组患者血清炎症指标均有明显的改善并下调,2组之间没有显著的不同;我们检测2组的NSE含量在第7天和14天存在统计学差异,BCAAs组的含量显著低于常规组。结论:支链氨基酸（BCAAs）可以通过下调NSE的含量,在治疗SAE时,能达到更好的治疗效果。从而,说明BCAAs可以在SAE的治疗中有着一定的疗效,在临床SAE的治疗中,BCAAs可以做为一种有效的干预措施,为SAE的治疗提供了新的方法和新思路。     

Suppressive effect of oral administration of branched-chain amino acid granules on oxidative stress and inflammation in HCV-positive patients with liver cirrhosis.

Aim: In chronic hepatitis C virus (HCV) infection, it is thought that both chronic persistent inflammation and oxidative stress contribute to the development of hepatocellular carcinoma (HCC), and it has been reported that long-term oral supplementation with branched-chain amino acid (BCAA) granules could inhibit liver carcinogenesis. However, the extent of the involvement of these factors remains obscure. Methods: To clarify the involvement of inflammation and oxidative stress in the inhibition of liver carcinogenesis, we evaluated the effect of oral administration of BCAA granules on oxidative stress and inflammation in HCV-positive patients with liver cirrhosis. Results: Twenty-seven patients were enrolled in the study: 18 of the patients were treated with BCAA granules (administered group) and nine were observed without BCAA granules (non-administered group). In the non-administered group, the production of oxidative stress, as indicated by urine 8-hydroxydeoxyguanosine (8-OHdG) and 15-F2t-Isoprostane (8-IsoPs), significantly increased with time, while in the administered group the levels of ferritin and 8-OHdG decreased significantly. Comparison of the two groups demonstrated that highly sensitive CRP, ferritin, 8-OHdG and 8-IsoPs were significantly reduced by taking BCAA granules. The time-course analysis showed that ferritin and highly sensitive CRP seemed to decrease first, followed by a decrease of 8-OHdG and 8-IsoPs. Conclusion: These findings indicated that the administration of BCAA granules influenced microinflammation and the metabolism of iron in HCV-positive patients with liver cirrhosis, and subsequently seemed to reduce the production of oxidative stress, possibly leading to a decrease in the occurrence of HCC.     

肺癌患者与正常人血、尿中氨基酸谱的对比研究

目的 了解肺癌患者体内氨基酸代谢特点,更合理地给予营养支持治疗。方法 采用习立835—50型氨基酸自动分析仪,检测30例肺癌患者及30例正常人血浆、尿液中游离氨基酸的含量。结果 肺癌患者血浆中芳香族氨基酸总量、苯丙氨酸、酪氨酸、蛋氨酸、半胱氨酸含量升高,支链氨基酸总量、异亮氨酸、亮氨酸、缬氨酸、精氨酸、苏氨酸含量降低,与正常人相比差异均有显著性（P〈0．05）;肺癌患者尿液中芳香族氨基酸总量、苯丙氨酸、酪氨酸、赖氨酸含量升高,亮氨酸含量降低,与正常人相比差异均有显著性（P〈0．05）。结论 肺癌患者“不平衡氨基酸疗法”应以大量补充精氨酸和适量补充支链氨基酸为主。     

Clinical significance of therapy using branched‐chain amino acid granules in patients with liver cirrhosis and hepatocellular carcinoma

The liver is the major organ for the metabolism of protein, fat and carbohydrate. A nutritional approach is required in the treatment of cirrhosis, which is frequently complicated with protein–energy malnutrition. Several advanced treatment approaches for hepatocellular carcinoma (HCC) have been established in the past decade. HCC is often complicated by cirrhosis, so treatment of the underlying liver diseases is also necessary to improve the prognosis. Branched‐chain amino acid (BCAA) granules were developed originally for the treatment of hypoalbuminemia associated with decompensated cirrhosis. However, subsequent studies found various other pharmacological actions of this agent. We review the clinical significance of therapy using BCAA granules in patients receiving different treatment approaches for cirrhosis and HCC based on the published work as well as our own data.