肠外应用谷氨酰胺治疗重症急性胰腺炎的Meta分析

Intravenous Glutamine for Severe Acute Pancreatitis: A Meta-analysis

目的评价肠外应用谷氨酰胺治疗重症急性胰腺炎的有效性。方法计算机检索中国生物医学文献数据库、中国知网、PubMed、EMbase及Cochrane图书馆临床对照试验数据库等,查找符合纳入标准的随机对照试验,文献检索时间均从建库截至2013年1月。通过使用由Cochrane协作网推荐的方法,对谷氨酰胺治疗重症急性胰腺炎的随机对照试验进行Meta分析。结果共纳入4篇随机对照试验,190例患者,这些试验均存在统计同质性。谷氨酰胺组比对照组病死率低[OR=0.26,95%CI(0.09,0.73),P=0.01],并发症发生率低[OR=0.41,95%CI(0.22,0.78),P=0.006],住院时间短[WMD=-4.85 d,95%CI(-6.67,-3.03)d,P<0.000 01]。结论据目前的证据,谷氨酰胺对于重症急性胰腺炎有效。

Objective To evaluate the efficacy of intravenous glutamine on patients with severe acute pancreatitis. Methods The Cochrane Library, PubMed, EMbase, CNKI and CBM databases were searched up to January 2013. Randomized controlled trials （RCTs） that compared non-glutamine nutrition with intravenous glutamine supplemented nutrition in patients with severe acute pancreatitis were included. A method recommended by the Cochrane Collaboration was used to perform a meta-analysis of those RCTs. Results Four RCTs involving a total of 190 participants were included. Analysis of these RCTs revealed the presence of statistical homogeneity among them. Results showed that glutamine dipeptide had a positive effect on reducing the mortality rate [OR=0.26, 95%CI （0.09, 0.73）, P=0.01], length of hospital stay [WMD=-4.85 d, 95%CI （-6.67, -3.03） d, P 〈 0.001], and the rate of complications [OR=0.41, 95%CI （0.22, 0.78）, P=0.006]. No serious adverse effects were found. Conclusions Current best evidence demonstrates that glutamine is effective for severe acute pancreatitis. Further high quality trials are required and parameters of nutritional condition and hospital cost should be considered in future RCTs with sufficient size and rigorous design.