肠内免疫营养治疗急性胰腺炎疗效的系统评价

Effectiveness of Enteral Immunonutrition in Acute Pancreatitis: A Systematic Review

目的系统评价肠内免疫营养对急性胰腺炎患者的治疗效果。方法计算机检索PubMed(1966～2012.8)、MEDLINE(Ovid,1946～2012.8)、CENTRAL(2012年第3期)、CBM(1978～2012.8)、CNKI(1979～2012.8)、VIP(1989～2012.8)、WanFang Data(1977～2012.8),查找有关采用肠内免疫营养治疗急性胰腺炎的随机对照试验(RCT),并手工检索相关资料追溯参考文献。由2位评价者根据纳入和排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入6个RCT,共197例患者。Meta分析结果显示,肠内免疫营养与常规肠内营养比较,在急性胰腺炎患者感染并发症的发生率、病死率、住院时间、治疗后C反应蛋白水平和白细胞计数、急性生理学及慢性健康状况评分Ⅱ方面,两者差异均无统计学意义。结论目前尚无急性胰腺炎患者使用肠内免疫营养优于普通肠内营养的证据。受纳入研究的数量与质量所限,上述结论尚待今后开展更多高质量、大样本的RCT验证,以探寻适宜于急性胰腺炎患者的肠内免疫营养剂的成分和剂量。

Objective To evaluate the eRectiveness ot enteral lmmunuuti,uu,v, r Methods The randomized controlled trials （RCTs） about enteral immunonutrition for patients with acute pancreatitis were searched in following databases： PubMed （1966 to August 2012）, MEDLINE （Ovid, 1946 to August 2012）, CEN TRAL （Issue 3, 2012）, CBM （1978 to August 2012）, CNKI （1979 August 2012）, VIP （1989 to August 2012）, and WanFang Data （1977 to August 2012）. The relevant materials and each reference of literature were also searched manually. Two reviewers independently screened the literature according to the predefined inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 197 patients were included. The results of meta-analysis showed that there were no significant differences between the enteral immunonutrition group and the routine enteral nutrition group in following aspects： infectious complications and mortality rate, length of stay, level of C-reactive protein and numeration of leucocyte after treatment, and APACHE II score. Conclusion At present, no evidence shows enteral immunutrition is superior to routine enteral nutrition in acute pancreatitis. For the quantity and quality limitation of the included studies, more high-quality and large-sample RCTs are required to investigate the proper ingredients and dosage of enteral immunonutrition suitable for patients with acute pancreatitis.