谷氨酰胺预防胃癌及结直肠癌化疗相关性腹泻的Meta分析

The Preventive Effect of Glutamine on the Chemotherapy Induced Diarrhea in Patients with Gastric Cancer and Colorectal Cancer:A Meta Analysis

目的:评价谷氨酰胺预防胃癌及结直肠癌化疗相关性腹泻的效果。方法:计算机检索Cochrane图书馆(1970年1月-2018年3月)、Pubmed(1966年1月-2018年3月)、EMBASE(1966年1月-2018年3月)和中国生物医学文献资料库(1978年1月-2018年3月)、万方医学(1978年1月-2018年3月)中收录的文献资料,查找谷氨酰胺预防胃癌及结直肠癌化疗相关性腹泻的随机对照试验。由2名研究者独立选择试验、提取资料和评估方法学质量,采用Cochrane图书馆提供的Rev Man 5.3软件进行统计学分析。结果:共有6篇文献入选,其中英文文献2篇、中文文献4篇,入选患者总例数为425例。Meta分析结果显示,与对照组相比,使用谷氨酰胺可以预防胃癌及结直肠癌化疗相关性腹泻(RR=0.46,P=0.00),且亚组分析结果显示,与对照组相比口服或静脉注射谷氨酰胺给药方式均可预防化疗相关性腹泻(RR=0.53,P=0.04;RR=0.38,P=0.01)。根据血浆D-乳酸检测结果显示,化疗后谷氨酰胺组的血浆D-乳酸显著低于对照组,差异有统计学意义(RR=-0.34,P=0.00)。结论:谷氨酰胺可以通过保护肠黏膜屏障的完整性起到预防胃癌及结直肠癌患者化疗相关性腹泻的作用。

Objective:To evaluate the effect of glutamine in preventing gastric cancer and colorectal cancer chemotherapy.Method:The literatures and corresponding references of randomized controlled trial(RCT)about glutamine in the prevention of chemotherapy induced diarrhea were searched from Cochrane Library(January 1970 to March 2018),Pubmed(January 1970 to March 2018),EMBASE(January 1970 to March 2018),China Biology Medicine disc(January 1970 to March 2018)and Wanfang database(January 1970 to March 2018).Literatures screening,data extraction and methodological quality assessment were individually performed by two researchers.The software RevMan 5.3 of Cochrane Collaboration was used for statistical analysis.Result:A total of 6 literatures,425 patients were included in this study.Meta analysis results showed that compared with the control group,glutamine could prevent chemotherapy induced diarrhea(RR=0.46,P=0.00),and the subgroup analysis results showed that compared with the control group,both of oral or intravenous glutamine could prevent chemotherapy related diarrhea(RR=0.53,P=0.04;RR=0.38,P=0.01).Also,results showed that D-Lactate of glutamine group after chemotherapy was significantly lower than control group(RR=0.34,P<0.00).Conclusion:Glutamine can prevent gastric cancer and colorectal cancer patients from chemotherapy induced diarrhea by protecting the integrity of intestinal mucosal barrier.