الفهرس 
Introduction and aim of the studyOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of
the liver and represents an important public health problem in Egypt.
TACE is the standard of care for patients with non-invasive, multinodular,
unresectable HCC and adequately preserved liver functions. TACE, particularly
when repeated, can result in liver toxicity and chemotherapy-related side effects,
which may influence retreatment decisions.
Recently L-carnitine has been proposed for treatment of various kinds of diseases,
including liver injury. Several studies have shown that L-carnitine administration
can ameliorate or prevent liver damage caused by variable aetiologies.
BCAA therapy demonstrated beneficial effects in the treatment of HCC patients
including; prolongation of survival, improvement of liver cirrhosis-related
complications, improvement of hepatic functional reserve and possibility of
suppression of HCC recurrence.
The present study aimed to investigate the effects of L-carnitine administration
before and after TACE on liver functions when administered solely or combined
with BCAA granules.
The study included 53 cirrhotic HCC patients who underwent TACE between
December 2012 and November 2013 at Osaka Medical College hospital, Osaka
japan. Three patients were withdrawn from the study. The study was prospective,
and the patients were randomly assigned into two groups;
1- The L-carnitine group :- included 24 HCC patients who received 600-mg of Lcarnitine daily starting from 2 weeks before TACE to 12 week after TACE.
Summary and Conclusion
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2-The control group :- included 26 HCC patients who did not receive L-carnitine
supplementations before or after TACE.
Study patients are classified into BCAA+ patients who received BCAA granules
before and throughout the study duration (N = 28) and BCAA- patients who did
not receive BCAA granules (N = 22). Follow up performed at 1,4 and 12 weeks
after TACE by clinical assessment, CP score and liver functions tests.
Written informed consent was obtained from all patients included in the study.
Our results revealed that L-carnitine provided early and late post-TACE
clinical benefits to cirrhotic HCC patients; L-carnitine prevented early postTACE deterioration of serum albumin and accomplished improvement of CP
scores, total bilirubin, and PT during post-TACE follow up. L-carnitine also
attenuated early post-TACE elevation of CRP and suppressed leukopenia
encountered after TACE. Development of ascites was diminished by L-carnitine
administration. Comparison between BCAA+ and BCAA– patients revealed
lesser post-TACE deterioration of CP scores and serum albumin in BCAA+
patients regardless L-carnitine therapy. BCAA combination with L-carnitine
exerted additive benefits to post-TACE CP scores, serum albumin, PT and CRP.
There were no reported adverse effects of L-carnitine or BCAA intake in any of
our study patients.
In conclusion, L-carnitine maintained and improved liver functions after TACE.
The hepatoprotective effects of L-carnitine in the current study were enhanced by
BCAA granules co-administration. L-carnitine and BCAA combination therapy
may be offered as a novel strategy in patients with HCC undergoing TACE.