短肠综合征营养康复治疗效果荟萃分析

Clinical evidence of nutritional rehabilitation for short bowel syndrome:a meta-analysis of clinical trials

目的系统评价营养康复治疗(生长激素、谷氨酰胺和高碳水化合物、低脂饮食)对短肠综合征病人预后的影响,以评估其有效性及安全性。方法检索1995年1月至2008年3月中国生物医学文献数据库、Cochrane图书馆、Medline数据库和EMBASE数据库,并鉴定随机对照研究(RCT)的质量,按Jadad质量评分进行评定,用RevMan4.2软件进行荟萃分析。结果2016篇相关文献中,纳入11项随机对照研究,共201例病人。分析结果表明:营养康复治疗对短肠综合征病人的体重、大便量、瘦体重、D-木糖吸收率和胰岛素样生长因子(IGF-1)等方面具有积极作用,但是在体脂、能量吸收率、碳水化合物吸收率、氮吸收率和脂肪吸收率方面无显著效果。结论生长激素、谷氨酰胺和高碳水化合物、低脂饮食的联合应用对于短肠综合征病人是安全有效的,同时需要进行更多,大样本,高质量的随机对照研究。

Objective To assess the safety and efficacy of growth hormone （GH） and glutamine （GLN） combined with a modified （high-carbohydrate-low-fat, HCLF） diet in patients with short bowel syndrome. Methods A meta-analysis of all the relevant clinical trials was performed. Clinical trials were identified from the following electronic databases between January 1995 and March 2008： MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in May 2008. Language was restricted to Chinese and English. Literature references were checked at the same time. Clinical trials were extracted and evaluated by two reviewers independently of each other. The statistical analysis was performed by Rev Man4.2 software which was provided by the Cochrane Collaboration. The value of P 〈0.05 was considered statistically significant. Results Eleven trials involving 201 patients were included. The combined results showed that GH, GLN and HCLF diet had positive treatment effect on body weight, stool output, lean body mass, absorption of D-xylose, and IGF-I. But there were no improvements in fat mass, absorption of energy, absorption of carbohydrates, absorption of nitrogen and absorption of fat. Conclusion Treatment with a combination of low-dose GH, GLN and HCLF diet is effective without any major adverse effects in patients with short bowel syndrome. Further trials are required, especially in children, with sufficient size and rigorous design.