强化支链氨基酸和谷氨酰胺的肠内营养支持对肝硬化病人的治疗作用

发布时间：2018-04-08 11:21

本文选题：肝硬化　切入点：支链氨基酸　出处：《肠外与肠内营养》2016年06期

【摘要】：目的:探讨强化支链氨基酸(BCAA)和谷氨酰胺(Gln)的肠内营养(EN)支持对肝硬化病人营养状况、肝功能和凝血功能的影响。方法:选择存在营养不良风险的肝硬化病人87例,随机分为对照组(n=44)和治疗组(n=43)。治疗组病人给予口服BCAA粉50 g/d和Gln 15 g/d;对照组给予等热量等氮的复方氨基酸颗粒。分别测定两组病人在营养治疗前、营养治疗第4周末和第9周末的营养指标(血清总蛋白、前清蛋白、清蛋白和转铁蛋白)、肝功能指标(丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总胆红素、直接胆红素)和凝血指标(凝血酶原时间测定和凝血酶原活动度)。分析比较两组病人治疗前后各项指标的变化。结果:治疗组病人的营养指标和肝功能指标在治疗第4周末和第9周末较治疗前和较对照组均有明显改善(P0.05)。而凝血指标的改善仅在治疗第9周末时有显著性差异(P0.05)。结论:强化BCAA和Gln的EN支持可增加肝硬化病人的蛋白质合成,改善其营养状况,有益于肝功能的恢复,进而防止肝性脑病的发生。
[Abstract]:Objective: to investigate the effects of enteral nutrition (en) with BCAA (BCAA) and glutamine (Glnn) on nutritional status, liver function and coagulation function in patients with liver cirrhosis.Methods: 87 patients with cirrhosis at risk of malnutrition were randomly divided into control group (n = 44) and treatment group (n = 43).Patients in the treatment group were given oral BCAA powder 50 g / d and Gln 15 g / d, while the control group was given compound amino acid granules of equal calorie and equal nitrogen.The nutritional indexes (serum total protein, prealbumin, albumin and transferrin) and liver function (alanine aminotransferase) were measured before and after nutrition treatment in the two groups.Aspartate aminotransferase, total bilirubin, direct bilirubin) and coagulation index (prothrombin time and prothrombin activity).The changes of indexes before and after treatment were analyzed and compared between the two groups.Results: the nutritional and liver function indexes of the patients in the treatment group were significantly improved at the end of the 4th and 9th weeks compared with those of the control group.The improvement of coagulation index was only significantly different at the end of the 9th week of treatment (P 0.05).Conclusion: enhanced en support of BCAA and Gln can increase protein synthesis, improve nutritional status of liver cirrhosis patients, and be beneficial to the recovery of liver function and prevent the occurrence of hepatic encephalopathy.
【作者单位】：山西医科大学公共卫生学院;山西医科大学第二医院营养科;
【分类号】：R575.2;R459.3

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