Moe-Byrne Thirimon, Brown Jennifer V E, McGuire William
Centre for Reviews and Dissemination, University of York, York, UK.
Cochrane Database Syst Rev. 2016 Jan 12(1):CD001457. doi: 10.1002/14651858.CD001457.pub5.
Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants.
To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants.
We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 12), MEDLINE, EMBASE and Maternity and Infant Care (to December 2015), conference proceedings and previous reviews.
Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital.
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 relative risk, typical risk difference and weighted mean difference.
We identified 12 randomised controlled trials in which a total of 2877 preterm infants participated. Six trials assessed enteral glutamine supplementation and six trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality. Meta-analysis did not find an effect of glutamine supplementation on mortality (typical relative risk 0.97, 95% confidence interval 0.80 to 1.17; risk difference 0.00, 95% confidence interval -0.03 to 0.02) or major neonatal morbidities including the incidence of invasive infection or necrotising enterocolitis. Three trials that assessed neurodevelopmental outcomes in children aged 18 to 24 months and beyond did not find any effects.
AUTHORS' CONCLUSIONS: The available trial data do not provide evidence that glutamine supplementation confers important benefits for preterm infants.
谷氨酰胺是一种条件必需氨基酸。在代谢应激状态下，内源性生物合成可能不足以满足组织需求。有证据表明，补充谷氨酰胺可改善危重症成人的临床结局。有人提出，补充谷氨酰胺可能对早产儿也有益处。
确定补充谷氨酰胺对早产儿死亡率和发病率的影响。
我们采用了Cochrane新生儿综述组的标准检索策略。这包括检索Cochrane对照试验中心注册库（CENTRAL，2015年第12期）、MEDLINE、EMBASE和母婴护理数据库（截至2015年12月）、会议论文集和以往的综述。
随机或半随机对照试验，比较从出生到出院的任何时间点，早产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，并报告典型相对风险、典型风险差和加权平均差。
我们确定了12项随机对照试验，共有2877名早产儿参与。6项试验评估了肠内补充谷氨酰胺，6项试验评估了肠外补充谷氨酰胺。这些试验的方法学质量总体良好。荟萃分析未发现补充谷氨酰胺对死亡率（典型相对风险0.97，95%置信区间0.80至1.17；风险差0.00，95%置信区间-0.03至0.02）或主要新生儿疾病（包括侵袭性感染或坏死性小肠结肠炎的发生率）有影响。3项评估18至24个月及以上儿童神经发育结局的试验未发现任何影响。
现有试验数据未提供证据表明补充谷氨酰胺对早产儿有重要益处。
