目的 了解β-羟基-β-甲基丁酸（HMB）对于髋部骨折老年患者肌肉减少症的临床有效性。方法选择2018年1月至2019年3月重庆市大足区人民医院骨科收治的符合入选标准的髋部骨折的老年患者，随机分为试验组（n=30）和对照组（n=28）。对照组给予常规营养治疗，试验组在对照组的基础上加用HMB治疗。并监测比较两组患者在3个时间点（0周、3周、6周）的体重、总蛋白、白蛋白、肌酐、握力、四肢骨骼肌质量、肺部感染发生的例数、Barthel指数>40分的例数的情况。结果试验组患者的体重、总蛋白、白蛋白、肌酐显著增高，差异有统计学意义（P<0.05）。试验组和对照组的ASMM都有所下降；但对照组明显大于试验组，差异有统计学意义（P<0.05）。患者握力的差异无统计学意义（P>0.05）。对照组肺部感染发生的例数明显多于试验组，差异有统计学意义（P<0.05）。Barthel指数>40分的人数明显多于对照组，差异有统计学意义（P<0.05）。结论通过HMB对老年人因髋部骨折长期卧床出现肌肉减少症治疗的临床研究，其在抑制肌肉和蛋白质分解，增加瘦体组织，改善患者营养不良状态均有明显效果。因此HMB应该在营养治疗领域有更好的应用。对于HMB对其他疾病是否有效，比如肿瘤、肝移植等疾病患者，其仍需进行大量临床实验、评估方法，进一步研究其作用临床效果。
Abstract
ObjectiveTo investigate the clinical efficacy of β-hydroxy-β-methylbutyrate acid in the treatment of muscular dystrophy in elderly patients with hip fracture. Methods From January 2018 to March 2019, the elderly patients with hip fracture who met the inclusion criteria were randomly divided into experimental group （n=30） and control group （n=28）. The control group was given conventional nutrition treatment, and the experimental group was treated with HMB on the basis of the control group. The weight, total protein, albumin, creatinine, grip strength, appendant skeletal muscle mass （ASMM）, the number of cases of pulmonary infection and the number of cases with Barthel index>40 were monitored and compared between the two groups at three time points （0, 3, 6 weeks）. ResultsThe body weight, total protein, albumin and creatinine of the patients in the experimental group increased significantly （P<0.05）. The ASMM of experimental group and control group decreased, but the difference was statistically significant （P<0.05）. There was no significant difference in grip strength （P>0.05）. The incidence of pulmonary infection in the control group was significantly higher than that in the experimental group （P<0.05）. The number of people whose Barthel index was more than 40 points was significantly higher than that of the control group （P<0.05）. ConclusionThrough the clinical study of HMB in the treatment of myopenia in elderly patients with hip fracture, it has obvious effects in inhibiting muscle and protein decomposition, increasing lean muscle and improving malnutrition status of patients. The incidence of pulmonary infection is relatively small, which can reduce the risk of death of patients, promote their rehabilitation and enhance their self-care ability to a certain extent. Prevention and reduction of muscle loss in hospitalized patients is one of the treatment factors clinicians should consider, so HMB should be better applied in the field of nutrition therapy. Whether HMB is effective for other diseases, such as tumors, liver transplantation and so on, still needs a lot of clinical experiments and evaluation methods to further study its clinical effect.
关键词
&beta /
-羟基-&beta /
-甲基丁酸 /
髋部骨折 /
老年患者 /
肌肉减少症 /
营养治疗
Key words
β-hydroxy-β-methylbutyrate /
Hip fracture /
Elderly patients /
Sarcopenia /
Nutritional therapy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1.Kristiansson J, Olsen F, Hagberg E, et al. Prolonged vasopressor support during hip-fracture surgery is a risk factor for enhanced mortality. Acta anaesthesiologica Scandinavica. 2019；63（1）:46-54.
2.Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci. 2013；68（10）:1236-1242.
3.Vellas B, Fielding R, Miller R, et al. Designing drug trials for sarcopenia in older adults with hip fracture －a task force from the International Conference on Frailty and Sarcopenia Research （ICFSR）. J Frailty Aging. 2014；3（4）:199-204.
4.Hida T, Ishiguro N, Shimokata H, et al. High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture.Geriatr Gerontol Int. 2013；13（2）:413-420.
5.Rosenberg IH. Summary comments:epidemiological and methodological problems in determining nutritional status of older persons. Am J Clin Nutr.1989；50:1231-1233.
6.Rosenberg IH. Sarcopenia:origins and clinical relevance. J Nutr.1997；127（5 Suppl）:990S-991S.
7.Morley JE, Baumgartner RN, Roubenoff R, et al. Sarcopenia. J Lab Clin Med. 2001；137（4）:231-243.
8.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: european consensus on definition and diagnosis. Age Ageing. 2010；39（4）:412-423.
9.Larsson L, Degens H, Li M.Sarcopenia:aging related loss of muscle mass and function. Physiological Reviews. 2019；99（1）:427-511.
10.Vincenzo M, Francisco U, Concetta M, et al. Effectiveness of nutri tional supplementation on sarcopenia and recovery in hip fracture patients.A multi-centre randomized trial. Maturitas. 2017；101:42-50.
11.洪维, 朱晓颖, 程群, 等. 老年髋部骨折患者肌肉减少症与骨密度的关系. 中华骨质疏松和骨矿盐疾病杂志. 2014；7（2）:106-112.
12.Kovarik M, Muthny T, Sispera L, et al. Effects of beta-hydroxy-beta-methylbutyrate treatment in different types of skeletal muscle of intact and septic rats. J Physiol Biochem. 2010；66 （4）:311-319．
13.王树英, 阎渭清. HMB对ICU肌肉减少患者的作用探讨. 肿瘤代谢与营养电子杂志. 2018；5（2）:212-215.
14.Bulgakova SV, Treneva EV, Zakharova NO, et al. The sarcopenia:a multicomponent strategy for therapy （review of literature）.Adv Gerontol. 2019；32（3）:405-414.
15.Jeschke MG, Chinkes DL, Finnerty CC, et al. Pathophysiologic response to severe burn injury. Ann Surg. 2008；248（3）:387-401.
16.Tisdale MJ. Mechanisms of cancer cachexia.Physiol Rev. 2009；89（2）:381-410.
17.Engelson ES, Agin D, Kenya S, et al. Body composition and metabolic effects of a diet and exercise weight loss regimen on obese, HIV-infected women. Metabolism. 2006；55（10）:1327-1336.
18.Brown AD, Close GL, Sharples AP, et al. Murine myoblast migration:influence of replicative ageing and nutrition. Biogerontology. 2017；18（6）:947-964.
19.Nissen SL, Abumrad NN. Nutritional role of the leucine metaboliteβ-hydroxy-β-Methylbutyrate （HMB）. J Nutr Biochem.1997；8:300-311.
20.Nissen S, Sharp R, Ray M, et al. The effect of the leucine metabolite-β-hydroxy-β-methylbutyrate on muscle metabolism during resistance exercise training. J Appl Physiol. 1996；81（5）:2095-2104.
21.Hao Y, Jackson JR, Wang Y, et al. β-Hydroxy-β-methylbutyrate reduces myonuclear apoptosis during recovery from hind limb suspension induced muscle fiber atrophy in aged rats. Am J Physiol Regul Integr Comp hysiol. 2011；301（3）:701-715.
22.苏琳, 刘爽, 董碧蓉. 营养与肌肉减少症. 肿瘤代谢与营养电子杂志. 2019；6（1）:26-34.
23.文星, 曾翔, 唐华. β-羟基-β-甲基丁酸治疗肿瘤恶病质的研究进展. 医学综述. 2019；25（3）:459-463,469.
24.鲁攀攀, 马彬彬,李荥娟, 等. 老年髋部骨折患者术前营养不良的危险因素分析. 中华老年骨科与康复电子杂志. 2018；4（3）:145-150.
25.张付峰, 卢晓琴. 肌肉减少症与肿瘤化疗. 肿瘤代谢与营养电子杂志. 2019；6（1）:110-115.
26.谢华, 陈敏, 乔莉华, 等. 握力指数在社区老年人营养不良筛查中的应用价值. 江苏大学学报（医学版）. 2018；28（6）:503-506,511.
27.Vogt BP, Borges MCC, Goés CR, et al. Handgrip strength is an independent predictor of all cause mortalit in maintenance dialysis patients. Clin Nutr. 2016；5（6）:1429-1433．
28.中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2017年版）. 中华糖尿病杂志. 2018；10（1）:4-67.
29.Zhang J, Upala S, Sanguankeo A. Ｒelationship between vitamin D deficiency and diabetic retinopathy: a meta-analysis. Can J Ophthalmol. 2017；52（Suppl 1）:S39-S44.
30.许倩. 老年髋部骨折病人不同危险因素对围术期发生肺部感染的影响临床研究.世界最新医学信息文摘. 2019；19（45）:73-74,77.
31.李莉, 陈念, 柯柳, 等. 老年髋部骨折围术期肺部感染危险因素分析. 中国组织工程研究. 2014；18（35）:5736-5740.
32.Mahoney FI, Barthel DW. Functional evalutation:The Barthel Index. Md State Med J. 1965；14:61-65.
33.Buurman BM, van Munster BC, Korevaar JC, et al. Variability in measuring （instrumental） activeties of daily living functioning and functional decline in hospitalized older medical patients: a systematic review. J Clin Epidemiol. 2011；64（6）:619-627.
34.González N, Ilbao A, Orjaz MJ, et al. sychometric characteristics of the Spanish version of the Barthel index. Aging Clin Exp Res. 2018；30（5）:489-449.
基金
重庆市卫生和计划生育委员会医学科研项目资助（2017MSXM184）
PDF(824 KB)
