分枝鏈氨酸輸液治療肝昏迷之臨床檢討

Clinical Evaluation of Branched Chain Amino Acids for Treatment of Hepatic Encephalopathy

柯成國(Chen-Guo Ker) ； 沈柏青(Pai-Ching Sheen)

《The Kaohsiung Journal of Medical Sciences》 2卷4期 (1986/04) Pp. 228-233

https://doi.org/10.6452/KJMS.198604.0228

摘要

肝昏迷為很困難治療之一種症候，也是慢性肝疾病的最後表徵，在肝昏迷時，患者血液中之分枝鏈氨基酸(branched chain amino acid, BCAA)與芳香族氨基酸（aromatic amino acid, AAA）之比值比正常者為低，所以針對肝昏迷患者輸入高濃度之BCAA特殊氨基酸輸液來提高血中BCAA濃度，可改善病人之意識程度。
本研究之對象有19位（男15，女4）均有腹水發生，除肝硬化外，其中有9位合併肝細胞癌，3位有肝內結石，1位肝內性膽汁滯流。按Parsons-Smith之意識型態分類其意識昏迷程度在ii度以上，才開始給予分枝氨基酸輸液，本研究給予病人含高濃度BCAA之THF（Todai hepatic fluid）輸液每500ml加上50%葡萄糖80 ml混合靜脈以2-3小時點滴注射，經過3至7日觀察其反應及其血中之氨改變情形。
結果分成三群，第一群為治療完全恢復者4位佔21.04%，第二群為有改善者10位佔52.64%，但皆因無法繼續供應THF輸液後而再度惡化，其中因肝衰竭而死亡有5位，另外因胃腸出血而死亡者亦有5位，第三群為治療無效而死亡者有5位佔26.31%，第二度昏迷病人治療後血中氨濃度有效改善，生存至6個月以上者2位（66.67%），iii度昏迷者當中在一週內死亡者2位（16.67%），治療有效而遊延死亡者8位（66.66%），治療有效活6個月以上2位（16.67%）。然而意識型態在iv度以上在一週內死亡者2位(50%)，遲延死亡者2位（50%），無一例活至6個月者，可見意型態嚴重者其預後不良。
肝昏迷之發生機轉仍有待分子醫學的努力，以這種BCAA之殊氨基酸輸液來治療肝昏迷是最近數年來的一種值得嘗試的新治療方法。

並列摘要

Branched chain amino acids have been recommended for the treatment of hepatic coma based on the decreased concentration of branched chain amino acids in the cirrhotic patients. The ratio of branched chain amino acids (BCAA) and aromatic amino acids (AAA) declines in the severe hepatic encephalopathy. Therefore, intravenous infusion of a high concentration of BCAA was proposed in the treatment of hepatic coma.
We conducted a clinical study on 19 patients, male in 15 abd female in 4, who had obvious ascites and hepatic coma. The underlying causes of those patients were hepatocellular carcinoma in 9, intrahepatic stones in 3 and intrahepatic cholestasis in 1, in addition to liver cirrhosis. Intravenous infusion of a high concentration of BCAA with THF(Todai hepatic fluid) 500 ml mixed with 50% glucose 80 ml per day was given for 3 to 7 days. Evaluation consciousness and determination of serum ammonia were studied before and after treatments. The consciousness levels were classified into 5 grades: grade 0: No abnormal, grade i: trivial lack of awareness, grade ii: lethargy or apathy, grade iii: somnolence to smi-stupor and confused, grade iv: coma.
Complete recovery was found in 4 patients (21.04%) in group i. In group ii, the patients had improved their consciousness and had a decreased level of serum ammonia during the treatment , but the infusion of THF solution was discontinous, and the patients become worse and died due to hepatic failure in 5 patients and massive gastrointestinal hemorrhage in 5 patients. In group iii, all 5 patients died within one week (26.13%).
The prognosis of hepatic coma was relative to the degree of consciousness level. Complete recovery and continued life for more than 6 months were found in 2 patients (66.67%) in grade ii, 2 patients (16.67%)in grade iii, and none in grade iv of consciousness level. Thus, a high concentration of branched chain amino acids was worthful in the treatment of hepatic encephlopathy.

並列關鍵字

hepatic encephalopathy ； amino acid solution ； branched chain amino acid