早产儿早期输注不同剂量氨基酸有效性和安全性的Meta分析

Meta-analysis of effectiveness and safety of early different doses of amino acid supplementation in preterm infants

目的评价早产儿早期输注不同剂量氨基酸的有效性和安全性。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库、万方数据库和中国生物医学文献数据库,检索时间为1990年1月至2010年3月,由2名系统评价员进行资料提取,根据随机分配方法 ,分配方案隐藏,对研究对象、治疗方案和研究结果测量者采用盲法,结果数据的完整性,选择性报告研究结果 ,其他偏倚来源进行文献质量评价。采用RevMan5.0.13软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型。结果共纳入14项研究(17篇文献),4项研究(5篇文献)评为B级,10项研究(12篇文献)评为C级。①早产儿早期输注高、极高、超高剂量与低剂量氨基酸比较,生后48h更易获得正氮平衡,差异有统计学意义,WMD分别为265.27(95%CI:252.77～277.78)、154.10(95%CI:145.00～163.21)和588.80(95%CI:574.56～603.04)。②早产儿早期输注高、极高剂量与低剂量氨基酸比较,生后7d内SCr、BUN、血三酰甘油、血胆固醇和血总胆红素水平差异均无统计学意义。③早产儿早期输注高、极高、超高剂量与低剂量氨基酸比较,生后28d内动脉导管未闭、慢性肺疾病、败血症、坏死性小肠结肠炎和颅内出血的发生率差异均无统计学意义。④3篇文献报道了早产儿早期输注高剂量和低剂量氨基酸对生后48h内血浆游离氨基酸水平的影响,1篇文献报道了早产儿早期输注极高剂量和低剂量氨基酸对生后48h内血浆游离氨基酸水平的影响。早期输注高或极高剂量氨基酸可普遍提高血浆游离氨基酸水平。结论早产儿生后24h内输注极高剂量氨基酸(2.0～3.0g.kg-1.d-1)可避免负氮平衡,对血生化指标没有影响,可增加早产儿血浆游离氨基酸水平,未见明显不良反应。考虑本Meta分析和纳入研究的局限性,还需通过多中心、大样本及双盲的RCT研究提供更高级别的证据。

Objective To assess the effectiveness and safety of early different doses of amino acid supplementation in preterm infants.Methods The Cochrane library,PubMed,EMBASE,CNKI and VIP till 31 March 2010 were searched.Two reviewers assessed the quality of included studies and extracted data.All included studies were graded on sequence generation,allocation concealment,blinding,incomplete outcome data,selective outcome reporting and other sources of bias.Statistical analysis was performed employing RevMan 5.0.13.Heterogeneity of the included articles was tested to select proper effective model.Results Fourteen studies（17 articles）were included.Four studies（5 articles）were graded B,10 studies（12 articles）were graded C.Compared with the early low doses of amino acid intake,early high,very high and extremely high doses of amino acid intake could gain a positive nitrogen balance significantly,the WMDs were 265.27（95%CI：252.77-277.78）,154.10（95%CI：145.00-163.21）and 588.80（95%CI：574.56-603.04）,respectively.There was no difference in the levels of blood creatinine,blood urea nitrogen,triglyceride,cholesterol,blood glucose,blood bilirabin or blood bicarbonate among groups received early low doses of amino acid intake and early high,very high doses of amino acid intake.There was no difference in the incidences of PDA,CLD,sepsis,NEC or intracranial hemorrhage among groups received early low doses of amino acid intake and early high,very high,extremely high doses of amino acid intake.Compared to the early low doses of amino acid intake,early high,very high doses of amino acid intake gained higher level of serum amino acid.Conclusions Early very high doses of amino acid supplementation（2.0-3.0 g·kg-1·d-1）in preterm infants in 24 h after birth could gain a positive nitrogen balance,did not affect the blood biochemical index,but increased the level of serum amino acid.Further multicentre and large-scale RCTs are still needed to evaluate the potential effectiveness and safety of early different doses of amino acid supplementation in preterm infants.