| Objective:The application of branched-chain amino acids(BCAA)in patients with cirrhosis remains controversial.The present study aimed to clarify the efficacy and safety of long-term enteral nutrition with BCAA in patients with cirrhosis and provide a basis for cl inical decision-making by systematically review the evidence available of BCAA in patients with cirrhosis.Methods:We identified randomized controlled trials(RCTs)about BCAA and any control intervention for the treatment of cirrhosis through electronic searches in databases including PubMed,EMbase,The Cochrane Library,CNKI,WanFang data,and Vip Database from January 2000 to July 2018.Two reviewers independently performed literature screening,data extraction,and bias risk assessment of the included literatures based on the study inclusion and exclusion criteria,the data extraction table,and the modified Jadad scale.Main outcome measure nutritional parameters,liver function index,survival analysis and safety analysis.Stata 14.0 software was used for statistical analysis.Based on the results of the heterogeneity test,it was decided to select a fixed effect model or a random effect model for meta-analysis,and further subgroup analysis is used to discuss the source of heterogeneity.Sensitivity analysis was performed by exclusion method.Publication bias was measured by Egger’s test.Results:A total of 13 RCTs involving 10 studies with low bias risk and 3 with high were included.1936 patients were followed up for 9 we eks to 6.3 years.The test group received BCAA supplements,the control group rece ived placebo/non-intervention(2 trials),regular diet(5 trials),whey protein or maltodextrin(1 trial),enteral nutrition preparation(3 trial),compound amino acid capsule(2 trial).Meta-analysis of the random-effects model found that serum albumin levels were elevated in the BCAA group compared with the control group(WMD=1.49g/L,95% CI 0.98 to 2.00,P< 0.001).Meta-analysis of the random effects model showed a significant improvement in serum amino acid profile in the BCAA group compared with the control group(WMD=0.41,95%CI 0.13 to 0.70,P=0.005).In subgroup analysis,the serum Fischer’s ratio of the BCAA group was significantly higher than that of the control group(WMD=0.59,95% CI 0.40 to 0.79,P< 0.001),while the change in BTR was not statistically different between the two groups(WMD=0.17,95%CI-0.18 to 0.51),P=0.348).In addition,the middle arm muscle circumference in BCAA group was higher than that in control group(WMD= 0.56 cm,95 % CI 0.20 to 0.93,P=0.003),but the results were unstable.Compared with the control group,the total bilirubin in the BCAA group were lower(WMD=-3.07μmol/L,95% CI-4.41 to-1.72,P< 0.001),while there was no statistical difference between the two groups in Child-Pugh scores(WMD=-0.82,95 % CI-1.80 to 0.17,P=0.105).In a fixed-effects model meta-analysis,the event-free survival rate was significantly higher in the BCAA group than in the control group(HR=0.65,95%CI 0.52 to 0.83,P<0.001).BCAA supplementation did not significantly increase the incidence of adverse reactions which were rare(2 cases),and the correlation with BCAA was not clear.Conclusion:1.This meta-analysis suggests that 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,but but improve the mid-arm muscle circumference unstablely.2.Long-term enteral nutrition with BCAA also has the potential to improve liver function and reduce serum total bilirubin levels.However,there is no significant effect on the Child-Pugh score.3.In addition,long-term BCAA enteral nutrition support intervention in patients with cirrhosis can effectively reduce events such as serious complications and death,improve event-free survival,and improve patient outcome.At the same time,it has good security. |
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