谷氨酰胺强化营养支持治疗重症急性胰腺炎疗效的Meta分析

Efficacy of glutamine enriched nutrition support for patients with severe acute pancreatitis： a Meta analysis

目的 系统评价谷氨酰胺强化营养支持治疗重症急性胰腺炎（SAP）的疗效.方法 以“glutamine”、“severe acute pancreatitis＂、“SAP”、“谷氨酰胺”、“重症急性胰腺炎”等为检索词检索PubMed、Embase、HighWire、Cochrane Central Register of Controlled Trials、万方数据库、中国期刊全文数据库（CJFD）、中国生物医学文献数据库（CBM）.检索时间为各数据库建库至2014年3月.最终纳入常规治疗对比谷氨酰胺强化营养支持治疗SAP疗效的随机对照试验,再由2名研究者独立筛查文献和提取数据,并进行文献质量评价,用RevMan 5.2软件进行Meta分析.所纳入研究中SAP的诊断标准为“Atlanta修订标准”或“中华医学会外科学分会胰腺外科学组SAP诊断与治疗指南”.计数资料采用相对危险度（RR）及95％可信区间（95％ CI）进行分析,计量资料采用标准均数差（SMD）及95％CI进行分析.采用I2对异质性进行定量分析.结果 共纳入符合标准的文献10篇,均为前瞻性随机对照研究.累计样本量433例,其中行常规治疗患者218例（对照组）,行谷氨酰胺强化营养支持治疗患者215例（实验组）.Meta分析结果显示：与对照组比较,实验组SAP患者Alb水平显著升高、C反应蛋白水平显著降低、住院时间显著缩短（SMD=1.00,-0.93,-0.71,95％CI：0.50～1.50,-1.25～-0.61,-1.10～-0.32,P＜0.05）,并发症发生率和病死率显著降低（RR =0.56,0.34,95％CI：0.41 ～0.77,0.15～0.76,P＜0.05）,且不增加患者住院费用（SMD =0.03,95％CI：-0.88 ～0.95,P＞0.05）.结论 谷氨酰胺强化营养支持治疗较常规治疗SAP的疗效具有一定优势.

Objective To systematically review the efficacy of glutamine enriched nutrition support for patients with severe acute pancreatitis （SAP）.Methods Database including PubMed,Embase,HighWire,Cochrane Central Register of Controlled Trials,Wanfang Database,CJFD and CBM were searched with ＂glutamine＂,＂severe acute pancreatitis＂,＂SAP＂,＂谷氨酰胺＂,＂重症急性胰腺炎＂.Literatures published before March 2014 were searched.Randomized controlled trials containing the comparison of conventional treatment and glutamine enriched nutrition support were enrolled in the study,and then the literatures were screened and the data were extracted by 2 independent reviewers.The quality of the literatures was assessed,and the data were analyzed using the RevMan 5.2 software.SAP was diagnosed according to ＂The revised Atlanta classificantion for acute pancreatitis＂ or ＂guideline for the diagnosis and treatment of SAP＂ which was composed by the pancreatic surgery Branch of Chinese Medical Association.The count data were analyzed using the relative risk （RR） and 95％ confidence interval （95％ CI）,and the measurement data were analyzed using standard mean difference （SMD） and 95 ％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Ten literatures including 433 cases were enrolled in the study,and all of them were prospective randomized controlled studies.There were 218 patients treated by conventional methods （control group） and 215 patients received glutamine enriched nutrition support （experimental group）.Compared with the control group,glutamine enriched nutrition support could elevate the albumin level,decrease the C-reaction protein level and shorten the hospital stay in the experimental group （SMD=1.00,-0.93,-0.71,95％CI：0.50-1.50,-1.25--0.61,-1.10--0.32,P＜0.05）,glutamine enriched nutrition support could decrease the morbidity and mortality （RR =0.56,0.34,95％ CI：0.41-0.77,0.15-0.76,P ＜ 0.05） without increasing the expenses （SMD =0.03,95％ CI：-0.88-0.95,P ＞ 0.05）.Conclusion Glutamine enriched nutrition support is superior to conventional methods for the treatment of SAP.