HEPATIC ENCEPHALOPATHY TREATED WITH BRANCHED-CHAIN AMINO ACIDS: REPORT OF 24 CASES

In view of the abnomalities of plasma amino acids in patients with hepatic encephalopathy （HE）, 24 patients with liver cirrhosis complicated by HE were treated with 4.275% branched-chain amino acids （BGAA） solution. Another 20 cases with similar condition but without using BCAA, were used as the controls.After intravenous infusion of BCAA, 14 patients awoke from unconsciousness within 24 hours, 5 within 48-96 hours. The improvement of mental state within 24 hours as compared with that in the control group showed significant differende （P＜0.01）. Plasma amino acids were abnomal in BCAA group before treatment, manifested as increase in phenylanine （PHE）, tyrosine （TYR） and decrease in valine （VAL）, leucine （LEU） isoleucine （ILE）, and the change of the ratio of VAL+LEU+ILE/PHE_TYR. After the infusion with BCAA, there was an excellent correlation of the improvement of HE and the elevation of plasma VAL, LEV, ILE and VAL+LEU+ILE/PHE+TYR ratio. As compared with the values before infusion, the differences were significant （P＜0.001）. Elctroencephalograms were abnomal in patients with HE, showing diffuse slowing and triphasic waved. After awakening slow waves disappeared. The findings in two patients of this series, however, suggest that protein intolerance may be ameliorated by BCAA infusion.