Wagner Jennifer V E, Moe-Byrne Thirimon, Grover Zubin, McGuire William
Centre for Reviews and Dissemination, University of York, York, UK.
Cochrane Database Syst Rev. 2012 Jul 11(7):CD005947. doi: 10.1002/14651858.CD005947.pub3.
Endogenous glutamine biosynthesis may be insufficient to meet the needs of people with severe gastrointestinal disease. Studies using experimental animal models and controlled trials in adult patients with severe gastrointestinal disease have suggested that glutamine supplementation improves clinical outcomes. This review examines evidence for the effect of glutamine supplementation in young infants with severe gastrointestinal disease.
To assess the evidence from randomised controlled trials that providing supplemental glutamine reduces mortality and morbidity in young infants with severe gastrointestinal disease.
We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2012, Issue 1), MEDLINE, EMBASE, and CINAHL (to November 2011), conference proceedings, and previous reviews.
Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in infants up to three months old (corrected for preterm birth if necessary) with severe gastrointestinal disease defined as a congenital or acquired gastrointestinal condition that is likely to necessitate providing parenteral nutrition for at least 24 hours.
We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical risk ratio (RR), typical risk difference (RD), and weighted mean difference (WMD).
We found two trials in which a total of 100 infants participated. The trials were of good methodological quality but were too small to detect clinically important effects of glutamine supplementation. Meta-analysis did not reveal a statistically significant difference in the risk of death before hospital discharge (typical RR 1.57; 95% confidence interval (95% CI) 0.25 to 9.66; RD 0.02; 95% CI -0.06 to 0.10) or in the rate of invasive infection [typical RR 1.22; 95% CI 0.55 to 2.70; RD 0.04; 95% CI -0.12 to 0.20).
AUTHORS' CONCLUSIONS: The available data from randomised controlled trials are insufficient to determine whether glutamine supplementation has any important benefits for young infants with severe gastrointestinal disease.
内源性谷氨酰胺的生物合成可能不足以满足患有严重胃肠道疾病患者的需求。使用实验动物模型以及针对患有严重胃肠道疾病的成年患者进行的对照试验表明，补充谷氨酰胺可改善临床结局。本综述探讨了补充谷氨酰胺对患有严重胃肠道疾病的幼儿的影响的证据。
评估来自随机对照试验的证据，即补充谷氨酰胺可降低患有严重胃肠道疾病的幼儿的死亡率和发病率。
我们采用了Cochrane新生儿综述小组的标准检索策略。这包括检索Cochrane对照试验中心注册库（《Cochrane图书馆》，2012年第1期）、MEDLINE、EMBASE和CINAHL（截至2011年11月）、会议论文集以及以往的综述。
随机或半随机对照试验，比较了对三个月龄以下（必要时根据早产情况校正）患有严重胃肠道疾病（定义为先天性或后天性胃肠道疾病，可能需要提供至少24小时肠外营养）的婴儿补充谷氨酰胺与不补充谷氨酰胺的情况。
我们使用Cochrane新生儿综述小组的标准方法提取数据，由两位综述作者分别评估试验质量和提取数据。我们使用固定效应模型合成数据，并报告典型风险比（RR）、典型风险差（RD）和加权均数差（WMD）。
我们发现两项试验，共有100名婴儿参与。这些试验方法学质量良好，但规模太小，无法检测到补充谷氨酰胺的临床重要效果。荟萃分析未显示出院前死亡风险（典型RR 1.57；95%置信区间（95%CI）0.25至9.66；RD 0.02；95%CI -0.06至0.10）或侵袭性感染率[典型RR 1.22；95%CI 0.55至2.70；RD 0.04；95%CI -0.12至0.20]存在统计学显著差异。
随机对照试验的现有数据不足以确定补充谷氨酰胺对患有严重胃肠道疾病的幼儿是否有任何重要益处。
