Qual dos aminoácidos de cadeia ramificada aumenta o fluxo cerebral na encefalopatia hepática? Ensaio clínico randomizado e duplo-cego
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Data
2018-09-12
Autores
Augusti, Laís [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Aminoácidos de cadeia ramificada aumentam a perfusão cerebral de pacientes com encefalopatia hepática (EH), mas o aminoácido responsável por esse aumento e os mecanismos envolvidos ainda não são conhecidos. Este estudo comparou a perfusão cerebral e a melhora clínica durante a suplementação de leucina ou isoleucina. Após a randomização, 27 indivíduos com cirrose e EH receberam suplementos de leucina ou isoleucina por um ano. Exames de tomografia computadorizada por emissão de fóton único (SPECT) e cintilografia cerebral dinâmica (DBS) foram realizados antes do estudo e após 1, 8 e 12 meses de suplementação. Apenas o grupo que recebeu isoleucina teve aumento da perfusão cerebral aos 8 meses de tratamento pelo exame de SPECT e pela cintilografia (p<0,001 e p = 0,05, respectivamente), também observado pelo SPECT aos 12 meses de suplementação (p < 0,05). O aumento do fluxo cerebral foi associado a melhora da EH aos 8 e 12 meses de suplementação (p=0,008 e 0,004, respectivamente), porém essa melhora não foi observada no grupo que recebeu leucina (p=0,313 e 0,055, respectivamente). A suplementação com isoleucina obteve melhor impacto na restauração da perfusão cerebral em pacientes com EH.
Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single photon emission computed tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p<0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p=0.008 and 0.004, respectively), which was not observed in the leucine group (p=0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE.
Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single photon emission computed tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p<0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p=0.008 and 0.004, respectively), which was not observed in the leucine group (p=0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE.
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encefalopatia hepática, cirrose hepática, aminoácidos de cadeia ramificada, perfusão cerebral, Hepatic encephalopathy, Liver cirrhosis, Branched-chain amino acids, Cerebral blood flow