Department of Emergency Medicine, Zhongshan Hospital, Dalian University, Dalian, China.
Graduate School, Dalian Medical University, Dalian, China.
Asia Pac J Clin Nutr. 2020;29(2):253-261. doi: 10.6133/apjcn.202007_29(2).0007.
Several studies have shown that glutamine (Gln) may play an important role in energy metabolism, inflammatory reactions, and immune processes in patients with severe acute pancreatitis (SAP). Nevertheless, the results of individual randomized controlled trials (RCTs) on Gln nutrition support for SAP are contradictory. This systematic review and meta-analysis evaluated the clinical benefit of Gln-supported early enteral nutrition (G+EEN) in patients with SAP.
Cochrane Library, PubMed, Embase, CNKI, Wan Fang, and Chinese Biomedical Literature Database were searched for relevant studies published before December 2018. RCTs of G+EEN versus standard early enteral nutrition (EEN) for SAP were selected, with both started within 48 h of admission.
Seven clinical RCTs including a total of 433 patients (EEN group: 218 patients; G+EEN group: 215 patients) were included. Compared with EEN, G+EEN increased serum albumin (standard mean difference [SMD]=0.74; 95% confidence interval [CI], 0.33-1.15; p<0.01), reduced serum hypersensitive C-reactive protein (SMD=-1.62; 95% CI, -1.98 to -1.26; p<0.01) and risks of mortality risk (risk ratio= 0.38; 95% CI, 0.16-0.90; p=0.03) and multiple organ dysfunction syndrome (MODS)(risk ratio=0.37; 95% CI, 0.15-0.94; p<0.01), and shortened length of hospital stay (SMD=-1.19; 95% CI, -1.88 to 0.49; p<0.01); moreover, it did not significantly increase the incidence of infection-related complications, operative interventions, or APACHE II scores.
G+EEN is beneficial in SAP management.
多项研究表明，谷氨酰胺（Gln）可能在重症急性胰腺炎（SAP）患者的能量代谢、炎症反应和免疫过程中发挥重要作用。然而，个别关于 Gln 营养支持 SAP 的随机对照试验（RCT）的结果存在矛盾。本系统评价和荟萃分析评估了 SAP 患者接受 Gln 支持的早期肠内营养（G+EEN）的临床获益。
检索 Cochrane 图书馆、PubMed、Embase、中国知网（CNKI）、万方和中国生物医学文献数据库，以获取截至 2018 年 12 月发表的相关研究。选择 Gln+EEN 与标准早期肠内营养（EEN）治疗 SAP 的 RCT，均在入院后 48 小时内开始。
纳入 7 项临床 RCT，共 433 例患者（EEN 组：218 例；G+EEN 组：215 例）。与 EEN 相比，G+EEN 增加了血清白蛋白（标准均数差 [SMD]=0.74；95%置信区间 [CI]，0.33-1.15；p<0.01），降低了血清超敏 C 反应蛋白（SMD=-1.62；95% CI，-1.98 至-1.26；p<0.01）和死亡率风险（风险比=0.38；95% CI，0.16-0.90；p=0.03）和多器官功能障碍综合征（MODS）（风险比=0.37；95% CI，0.15-0.94；p<0.01），并缩短了住院时间（SMD=-1.19；95% CI，-1.88 至 0.49；p<0.01）；此外，它并没有显著增加感染相关并发症、手术干预或急性生理和慢性健康评估 II 评分的发生率。
G+EEN 对 SAP 的治疗有益。
