Brown Jennifer V E, Moe-Byrne Thirimon, McGuire William
Centre for Reviews and Dissemination, University of York, York, UK.
Cochrane Database Syst Rev. 2014 Dec 15;2014(12):CD005947. doi: 10.1002/14651858.CD005947.pub4.
Endogenous glutamine biosynthesis may be insufficient to meet the needs of people with severe gastrointestinal disease. Results from studies using experimental animal models of gastrointestinal disease have suggested that glutamine supplementation improves clinical outcomes. This review examines evidence on the effect of glutamine supplementation in young infants with severe gastrointestinal disease.
To assess the effect of supplemental glutamine on mortality and morbidity in young infants with severe gastrointestinal disease.
We searcheed the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 8), MEDLINE, EMBASE, and CINAHL (from inception to September 2014), conference proceedings, and reference lists from 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.
Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio (RR) and risk difference (RD) for dichotomous data and mean difference for continuous data, with 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses.
We found three trials in which a total of 274 infants participated. The trials were of good methodological quality but were too small to detect clinically important effects of glutamine supplementation. Meta-analyses did not reveal a statistically significant difference in the risk of death before hospital discharge (typical RR 0.79, 95% CI 0.19 to 3.20; typical RD -0.01, 95% CI -0.05 to 0.03) or in the rate of invasive infection (typical RR 1.37, 95% CI 0.89 to 2.11; typical RD 0.08, 95% CI -0.03 to 0.18]).
AUTHORS' CONCLUSIONS: The available data from randomised controlled trials do not suggest that 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。使用胃肠道疾病实验动物模型的研究结果表明，补充谷氨酰胺可改善临床结局。本综述考察了补充谷氨酰胺对患有严重胃肠道疾病的幼儿的影响的相关证据。
评估补充谷氨酰胺对患有严重胃肠道疾病的幼儿死亡率和发病率的影响。
我们检索了Cochrane对照试验中心注册库（《Cochrane图书馆》，2014年第8期）、MEDLINE、EMBASE和CINAHL（从创刊至2014年9月）、会议论文集以及以往综述的参考文献列表。
随机或半随机对照试验，比较了对3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。
两位综述作者独立评估试验的合格性和偏倚风险，并进行数据提取。我们分析了各个试验中的治疗效果，并报告了二分数据的风险比（RR）和风险差（RD）以及连续数据的均值差，并给出95%置信区间（CI）。我们在Meta分析中使用固定效应模型，并在敏感性分析中探究异质性的潜在原因。
我们发现了三项试验，共有274名婴儿参与。这些试验方法学质量良好，但规模太小，无法检测出补充谷氨酰胺的临床重要效果。Meta分析未显示出院前死亡风险（典型RR 0.79，95%CI 0.19至3.20；典型RD -0.01，95%CI -（此处疑似有误，原文为-0.05至0.03，推测此处应为-0.05）0.05至0.03）或侵袭性感染率（典型RR 1.37，95%CI 0.89至2.11；典型RD 0.08，95%CI -0.03至0.18）有统计学显著差异。
来自随机对照试验的现有数据并不表明补充谷氨酰胺对患有严重胃肠道疾病的幼儿有任何重要益处。
