谷氨酰胺强化的营养支持对围手术期肿瘤患者预后影响的Meta分析

Effect of glutamine reinforced nutrition support on clinical outcomes of perioperative cancer patients: a meta analysis

目的系统评价谷氨酰胺(Gln)强化的营养支持对围手术期肿瘤患者预后的影响。方法检索6个生物医学数据库(《Pubmed数据库》、《Springer Link数据库》、《中国生物医学文献数据库》、《Cochrane Library》、《中国学术期刊全文数据库》等)的文献资料。按照Cochrane系统评价员手册,对纳入随机对照研究进行方法学质量评定,应用Rev Man 5.2软件进行Meta分析。结果共纳入9项符合标准的RCT相关文献(n=921)。Meta分析显示,谷氨酰胺增强化的实验组与对照组比较可使患者临床感染率降低至65%,95%CI[0.47,0.90],P=0.010,具有统计学意义;患者总住院时间平均缩短1.95 d,95%CI[-3.03,-0.87],P=0.000 4,具有统计学差异;患者的IgG平均增加1.27 g/L,95%CI[0.80,1.73],P<0.000 01,具有统计学意义。结论谷氨酰胺强化的营养支持,能有效地降低外科腹部手术患者术后感染风险,提高免疫功能,缩短患者住院时间,具有一定的卫生经济学意义。谷氨酰胺强化的营养支持是一种安全有效的营养治疗方法 ,有利于围手术期肿瘤患者的康复。

Objective To assess the application of glutamine reinforced nutrition support in perioperative cancer patients. Methods Literatures were retrieved by computer from electronic databases, including Pubmed, Springer Link, CBM disk, Cochrane Library and CNKI. The quality of included randomized clinical trials（RCT） was evaluated according to Cochrane＇s quality scale of reports and Meta analysis was conducted with software Rev Man 5.0. Results Fourteen relevant RCT studies were selected and 1 110 cases were included. Meta analysis showed that the infection risk was significantly lower in glutamine group than that in control group （ RR： 0.65,95 % CI E 0. 47 , 0. 901, P = 0.010）. The mean hospital days were reduced by 1.95 days （95 % CI ： - 3.03, - 0.87, P = 0.000 4）. The mean IgG was elevated by 1.27 g/L95% CI E 0.80, 1.73 ] P 〈 0. 000 01. Conclusion Glutamine reinforced nutrition support can reduce the infection risk and length of hospital stay, and improve the immune function in perioperative cancer patients.