Zhong Xin, Liang Cui-Ping, Gong Shu
Xin Zhong, Cui-Ping Liang, Shu Gong, Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Crit Care Med. 2013 Feb 4;2(1):4-8. doi: 10.5492/wjccm.v2.i1.4.
To evaluate the efficacy of intravenous glutamine on the patients with severe acute pancreatitis (SAP).
The Cochrane Library, PubMed, EMBASE, and EBM review databases were searched up to June 2012. Randomized controlled trials (RCTs) that compared non-glutamine nutrition with intravenous glutamine supplemented nutrition in patients with SAP were included. A method recommended by the Cochrane Collaboration was used to perform a meta-analysis of those RCTs.
Four RCTs involving a total of 190 participants were included. Analysis of these RCTs revealed the presence of statistical homogeneity among them. Results showed that glutamine dipeptide has a positive effect in reducing the mortality rate (OR = 0.26, 95%CI: 0.09-0.73, P = 0.01), length of hospital stay (weighted mean difference = -4.85, 95%CI: 6.67--3.03, P < 0.001), and the rate of complications (OR = 0.41, 95%CI: 0.22-0.78, P = 0.006). No serious adverse effects were found.
Current best evidence demonstrates that glutamine is effective for SAP. Further high quality trials are required and parameters of nutritional condition and hospital cost should be considered in future RCTs with sufficient size and rigorous design.
评估静脉输注谷氨酰胺对重症急性胰腺炎（SAP）患者的疗效。
检索截至2012年6月的Cochrane图书馆、PubMed、EMBASE和EBM综述数据库。纳入比较非谷氨酰胺营养与静脉补充谷氨酰胺营养的SAP患者的随机对照试验（RCT）。采用Cochrane协作网推荐的方法对这些RCT进行荟萃分析。
纳入4项RCT，共190名参与者。对这些RCT的分析显示它们之间存在统计学同质性。结果表明，谷氨酰胺二肽在降低死亡率（OR = 0.26，95%CI：0.09 - 0.73，P = 0.01）、住院时间（加权平均差 = -4.85，95%CI：6.67 - 3.03，P < 0.001）和并发症发生率（OR = 0.41，95%CI：0.22 - 0.78，P = 0.006）方面有积极作用。未发现严重不良反应。
目前最佳证据表明谷氨酰胺对SAP有效。需要进一步开展高质量试验，未来有足够规模和严谨设计的RCT应考虑营养状况参数和住院费用。
