肠内营养补充谷氨酰胺治疗重度急性胰腺炎的meta分析

Meta-analysis of Glutamine-supplemented Enteral Nutrition in Treatment of Severe Acute Pancreatitis

背景:肠内营养是治疗重度急性胰腺炎(SAP)的必要手段,而对是否添加谷氨酰胺尚无定论。目的:系统性评价肠内营养补充谷氨酰胺对SAP病情和预后的影响。方法:计算机检索中国知网、万方、重庆维普、中国生物医学文献服务系统、The Cochrane Library、Pub Med、Embase、Web of Science等数据库,搜索建库至2020年6月有关肠内营养补充谷氨酰胺治疗SAP的随机对照试验(RCT)。按照纳入与排除标准筛选文献、评价质量并提取数据,应用Rev Man 5.2软件进行meta分析。结果:共纳入18篇文献、1 119例患者。Meta分析结果显示,与标准肠内营养相比,补充谷氨酰胺的肠内营养可降低APACHEⅡ评分(MD=-2.20,95%CI:-2.70~-1.71,P <0.000 01)、CRP(SMD=-1.20,95%CI:-1.37~-1.02,P <0.000 1)、IL-6 (SMD=-2.09,95%CI:-2.31~-1.87,P <0.000 01)、TNF-α(SMD=-2.61,95%CI:-2.82~-2.39,P <0.000 01),缩短住院时间(MD=-4.84,95%CI:-8.08~-1.60,P=0.003);但两组并发症发生率(RR=0.84,95%CI:0.66~1.06,P=0.15)和死亡率(RR=0.88,95%CI:0.51~1.51,P=0.64)相比无明显差异。结论:肠内营养补充谷氨酰胺可降低SAP患者的炎症水平,改善病情严重程度,但对其并发症发生率和死亡率无明显影响。

Background: Enteral nutrition is an essential component for treatment of severe acute pancreatitis( SAP),yet there is no consensus on whether glutamine should be added in the enteral nutrition. Aims: To systematically evaluate the effect of glutamine-supplemented enteral nutrition on the condition and prognosis of SAP. Methods: Randomized controlled trials( RCT) on the effect of glutamine-supplemented enteral nutrition in the treatment of SAP were retrieved from CNKI,Wanfang,VIP,Sino Med,The Cochrane Library,Pub Med,Embase and Web of Science from the date of database foundation to June 2020. Literatures were enrolled according to the inclusion and exclusion criteria,and the quality was evaluated and data were extracted. Rev Man 5. 2 software was used to conduct meta-analysis. Results: A total of 18 RCT involving 1 119 patients were included. Meta-analysis showed that glutamine-supplemented enteral nutrition could decrease APACHEⅡ score( MD =-2. 20,95% CI:-2. 70--1. 71,P < 0. 000 01),CRP( SMD =-1. 20,95% CI:-1. 37--1. 02,P < 0. 000 1),IL-6( SMD =-2. 09,95% CI:-2. 31--1. 87,P < 0. 000 01),TNF-α( SMD =-2. 61,95% CI:-2. 82--2. 39,P < 0. 000 01) when compared with conventional enteral nutrition,and could shorten the hospital stay( MD =-4. 84,95% CI:-8. 08--1. 60,P = 0. 003). However,no significant differences in the incidence of complications( RR = 0. 84,95% CI: 0. 66-1. 06,P = 0. 15) and mortality( RR = 0. 88,95% CI: 0. 51-1. 51,P =0. 64) were found between the two groups. Conclusions: Glutamine-supplemented enteral nutrition can reduce the inflammation level and improve the severity of SAP,but it has no effect on the incidence of complications and mortality.