Intervention Study Of Branched Chain Amino Acids And Glutamine Enriched Enteral Nutrition On Patients With Cirrhosis

Objective:This study aims at researching the effect of enteral nutrition reinforced by branched chain amino acids(BCAA)and glutamine on patients with liver cirrhosis,by observing clinical symptoms,nutritional status,liver function,blood coagulation function,and immune function.In order to alleviate clinical symptoms,improve the nutritional status,liver function,blood coagulation and immune function of patients,and ultimately improve patients’ prognosis,reduce the hospital costs.A feasible programs of enternal nutrition will be presented for patients with liver cirrhosis.Method:116 patients with liver cirrhosis in Department of Gastroenterology of the second hospital of Shanxi Medical University were selected and randomly divided into control group(n = 58)and intervention group(n = 58).Two groups of patients were treated with conventional enteral nutrition(per kilogram of body weight standard for energy146kJ/d,protein 1.4g/d),in addition,the control group were provided Compound Amino Acid Granules 17.5g/d(Nitrogen content: 1.78 g,BCAA content: 3.88g)while the intervention group were given nutritional preparation of BCAA 50g/d(Nitrogen content:1.78 g,BCAA content :5.55g)and 0.3g/(kg·d).The intervention lasted for nine weeks,during this period the clinical symptoms of patients were observed,and venous blood samples were collected to test indexes before the nutrition intervention,at the end of the fourth week and the end of the ninth week morning.Detection indicators included nutritious indicators: total serum protein(TP),prealbumin(PA),albumin(ALB),transferrin(TRF);liver function parameters: alanine aminotransferase(ALT),aspartate aminotransferase(AST),totalbilirubin(TBIL),direct bilirubin(DBIL)coagulation parameters: prothrombin time assay(PT),prothrombin activity(PTA);immune parameters: T lymphoid cell subsets(CD4~+,CD8~+,CD4~+/CD8~+).Result:1.Clinical symptoms: during the intervention period,patients in two groups were in stable condition,after nine weeks intervention,intervention group patients with fatigue,loss of appetite,diarrhea or constipation symptoms significantly improved compared with the control group(P<0.05).2.Nutrition indicators: before the nutrition intervention,nutrition indicators were compared between the two groups(P>0.05).Compared with before,nutrition indicators,TP,PA,ALB and TRF of intervention group were significantly improved at the end of the fourth week and the end of the ninth week(P<0.05).Compared with the control group,TP,PA,ALB and TRF were significantly improved in the intervention group at the end of the fourth week and the end of the ninth week(P<0.05).3.Liver function indicators: before the nutrition intervention,liver function indicators were compared between the two groups(P>0.05).Compared with before,liver function indicators,ALT,AST,TBIL and DBIL of intervention group were significantly improved at the end of the fourth week and the end of the ninth week(P<0.05).Compared with the control group,ALT,AST,TBIL and DBIL were significantly improved in the intervention group at the end of the fourth week and the end of the ninth week(P<0.05).4.Coagulation indicators: before the nutrition intervention,PT and PTA were compared between the two groups(P>0.05).Compared with before,coagulation parameters,PT and PTA of intervention group patients were improved significantly at the end of the ninth week(P< 0.05),while there was no significant difference at the end of the fourth week(P> 0.05).Compared with the control group patients,PT and PTA of the intervention group patients were improved significantly at the end of the ninth week(P <0.05),but at the end of the fourth week there was no statistically significant difference(P >0.05).5.Immune indicators: before nutrition intervention,the balance of T lymphocytesubsets was comparable(P>0.05).At the end of the fourth week and the end of the ninth week,the CD4~+ and CD4~+/CD8~+ of the intervention group were significantly improved compared with those before the intervention and the control group(P<0.05).During the intervention,the two groups of patients with CD8~+ had no significant difference between the individual groups(P>0.05).Conclusion:The enteral nutrition reinforced by BCAA and glutamine has these effects:1.reducing the clinical symptoms of patients with cirrhosis significantly,preventing the deterioration of the disease;2.improving the nutritional status of patients with liver cirrhosis,increasing protein levels;3.restoring the liver function of patients with liver cirrhosis,promoting the normal metabolism of nutrients;4.shorten the prothrombin time,increasing prothrombin activity,improving the coagulation function of patients with liver cirrhosis;5.regulating the immune function in patients with liver cirrhosis,reducing the incidence of infectious complications.