谷氨酰胺对肝胆手术病人肝功能与免疫功能影响的Meta分析

Effect of glutamine enriched nutrition support on liver function and immune function of patients undergoing hepatobiliary surgery:a Meta-analysis

目的系统评价谷氨酰胺(glutamine,Gln)免疫营养对肝胆外科手术病人术后免疫功能和肝功能的影响。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库关于Gln免疫营养对肝胆外科病人术后免疫功能和肝功能影响的随机对照试验,检索时限均从建库至2016年3月。由2名研究员按照纳入标准筛选文献,提取资料和评价文献质量后,采用RevMan5.2软件进行Meta分析。结果共有13篇随机对照试验符合纳入标准。Meta分析结果显示:Gln免疫营养可促进肝功能指标丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、前白蛋白(PAB)的恢复,其中PAB、AST指标与不加Gln对照组相比,差异有统计学意义(MD=31.94,95%CI:3.49,60.40,P<0.05;MD=-21.43,95%CI:-40.17,-2.69,P<0.05)。两组免疫指标比较,其中T淋巴细胞亚群CD3^+、CD4^+及免疫球蛋白IgG、IgA指标与不加Gln对照组相比,差异有统计学意义(MD=7.09,95%CI:5.44,8.74,P<0.05;MD=6.02,95%CI:4.63,7.42,P<0.05;MD=2.44,95%CI:0.10,4.77,P<0.05;MD=0.7,95%CI:0.36,1.04,P<0.05)。结论 Gln免疫营养对肝胆外科病人术后应激状态下的肝功能和免疫功能有一定的改善和调理作用。

Objective To evaluate the impact of the glutamine enhanced nutrition on immune function and liver function of patients undergoing hepatobiliarysurgery.Methods PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,and Wanfang databases were searched,and other sources were also retrieved to collect the randomized controlled trials aboutglutamine enriched nutrition support for liver function and immune function of the patients undergoing hepatobiliarysurgery.After literature screening,data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria,the Meta-analysis was conducted using RevMan 5.2 software.Results Thirteen studies were included in the Meta-analysis.The analysis showed that as compared with the control groups,Gln enriched nutrition support was more effective in improving the liver function including prealbumin（PAB）and AST [MD=31.94,95%CI（3.49-60.40）,P〈0.05;MD=-21.43,95%CI（-40.17-2.69）,P〈0.05].Meanwhile,it could also improve the immune function including CD3,CD4,IgG,IgA [MD=7.09,95%CI（5.44-8.74）,P〈0.05;MD=6.02,95%CI（4.63-7.42）,P〈0.05;MD=2.44,95%CI（0.10-4.77）,P〈0.05;MD=0.7,95%CI（0.36-1.04）,P〈0.05].Conclusions Glutamine enriched nutrition support was effective in improving liver function and immune function and may play an important role in the rehabilitation of patients undergoing hepatobiliarysurgery.