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Verzweigtkettige Aminosäuren bei der Behandlung der latenten portosystemischen Enzephalopathie Eine placebokontrollierte Doppelblind-Cross-over-Studie

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Zusammenfassung

In einer placebokontrollierten Doppelblind-Cross-over-Studie an 22 stationären Kranken mit Leberzirrhose wurde die Wirksamkeit der oralen Zufuhr von VKAS geprüft. Mit Hilfe eines ausführlichen psychometrischen Test-programms war bei diesen Patienten eine latente (subklinische) portosystemische Enzephalopathie nachgewiesen worden. Die Kranken erhielten eine definierte Diät mit 35 kcal und 1 g Protein pro kg/Tag. Zusätzlich wurden verzweigtkettige Aminosäuren bzw. Kasein in einer Dosierung von 0,25/kg/Tag im Cross-over-Verfahren für jeweils eine Woche verabreicht. Die semiquantitative Stickstoffbilanz erhöhte sich unter beiden Behandlungen, wobei die Tendenz zu einem stärkeren Anstieg unter der Behandlung mit VKAS bestand. Gleichzeitig tendierte die Ammoniakkonzentration unter der Behandlung mit VKAS zu einer Abnahme. Unter Berücksichtigung des Cross-over-Modells konnten signifikante, auf die Behandlung mit VKAS zurückzuführende Verbesserungen der psychomotorischen Funktionen (Liniennachfahren, Tapping, Steadiness, akustische Reaktionszeit), der Aufmerksamkeit (Zahlentafel) und der praktischen Intelligenz (Zahlensymboltest, Zahlenverbindungstest) nachgewiesen werden.

Summary

In a doubleblind cross-over placebo-controlled trial the efficiency of oral treatment with branched chain amino acids was investigated in 22 inpatients with liver cirrhosis. In all patients evidence of latent (subclinical) portalsystemic encephalopathy was obtained by using an extensive psychometric test programme.

Patients received a defined diet of 35 cal/kg/day containing 1 g of protein. In addition, branched chain amino acids or casein in a dosage of 0.25 g/kg/day was administered in a cross-over fashion, each for 1 week. Semiquantitative nitrogen balance increased during both treatments, with a tendency towards a larger increase during branched chain amino acid treatment. At the same time ammonia concentration tended to decrease during branched chain amino acid treatment. Taking into account the cross-over design, significant improvements attributable to branched chain amino acid treatment could be demonstrated in psychomotor functions (line tracing, tapping, steadiness, auditory reaction time), attention (digit table), and practical intelligence (digit symbol, number connection test).

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Abbreviations

VKAS:

verzweigtkettige Aminosäuren

PSE:

portosystemische Enzephalopathie

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Egberts, E.H., Schomerus, H., Hamster, W. et al. Verzweigtkettige Aminosäuren bei der Behandlung der latenten portosystemischen Enzephalopathie Eine placebokontrollierte Doppelblind-Cross-over-Studie. Z Ernährungswiss 25, 9–28 (1986). https://doi.org/10.1007/BF02023616

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