Dong Shi, Zhao Zhenjie, Li Xin, Chen Zhou, Jiang Wenkai, Zhou Wence
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
Front Nutr. 2022 Jun 14;9:865102. doi: 10.3389/fnut.2022.865102. eCollection 2022.
The prognosis of severe acute pancreatitis (SAP) patients is closely related to early nutritional support. It is well-established that changes in glutamine (Gln), an important amino acid and nutritional supplement, can reflect disease severity. However, no consensus has been reached on the role of Gln nutrition therapy for SAP patients. We conducted this systematic review and meta-analysis to summarize and evaluate the advantages of Gln supplementation in SAP.
PubMed, Web of Science, the Embase, Cochrane Library, and Chinese databases (CNKI, SinoMed, Wanfang, and VIP) were systematically searched for eligible studies that included glutamine supplementation in SAP patients from inception to October 31 2021, excluding non-SAP studies. Primary outcome measures included mortality, APACHE II score, complications, and length of hospital stay. The meta-analysis was registered with PROSPERO (CRD42021288371) and was conducted using Review Manager and Stata softwares.
This meta-analysis included 30 randomized controlled trials (RCTs) with a total of 1,201 patients. Six primary outcomes and six secondary outcomes were analyzed. For the primary outcomes, Gln supplementation was associated with lower mortality (OR = 0.38, 95% CI: 0.21-0.69, = 0.001), total hospital stay (MD = -3.41, 95% CI: -4.93 to -1.88, < 0.0001) and complications (OR = 0.45, 95% CI: 0.31-0.66, < 0.0001) compared with conventional nutrition. Further subgroup analysis found that parenteral glutamine was more effective in reducing mortality. In terms of secondary outcomes, Gln supplementation helped restore liver, kidney and immune function, with significantly increased serum albumin (SMD = 1.02, 95% CI: 0.74-1.31, < 0.00001) and IgG levels (MD = 1.24, 95% CI: 0.82-1.67, < 0.00001), and decreased serum creatinine (Scr) (MD = -12.60, 95% CI: -21.97 to -3.24, = 0.008), and inflammatory indicators such as C-reaction protein (CRP) (SMD = -1.67, 95% CI: -2.43 to -0.90, < 0.0001).
Although Gln supplementation is not routinely recommended, it is beneficial for SAP patients. Indeed, glutamine nutrition has little effect on some indicator outcomes but contributes to improving the prognosis of this patient population. PROSPERO (york.ac.uk). Unique Identifier: CRD42021288371.
重症急性胰腺炎（SAP）患者的预后与早期营养支持密切相关。谷氨酰胺（Gln）作为一种重要的氨基酸和营养补充剂，其变化能够反映疾病的严重程度，这一点已得到充分证实。然而，对于Gln营养治疗在SAP患者中的作用，尚未达成共识。我们进行了这项系统评价和荟萃分析，以总结和评估补充Gln对SAP的益处。
系统检索了PubMed、Web of Science、Embase、Cochrane图书馆和中文数据库（中国知网、中国生物医学文献数据库、万方数据和维普资讯），以查找从起始至2021年10月31日期间纳入了SAP患者补充谷氨酰胺的符合条件的研究，排除非SAP研究。主要结局指标包括死亡率、急性生理与慢性健康状况评分系统II（APACHE II）评分、并发症及住院时间。该荟萃分析已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42021288371）注册，并使用RevMan和Stata软件进行。
该荟萃分析纳入了30项随机对照试验（RCT），共1201例患者。分析了6项主要结局和6项次要结局。对于主要结局，与传统营养相比，补充Gln与较低的死亡率（比值比[OR]=0.38，95%置信区间[CI]：0.21 - 0.69，P=0.001）、总住院时间（平均差[MD]= - 3.41，95%CI： - 4.93至 - 1.88，P<0.0001）及并发症（OR = 0.45，95%CI：0.31 - 0.66，P<0.0001）相关。进一步的亚组分析发现，肠外补充谷氨酰胺在降低死亡率方面更有效。在次要结局方面，补充Gln有助于恢复肝脏、肾脏和免疫功能，血清白蛋白水平显著升高（标准化均数差[SMD]=1.02，95%CI：0.74 - 1.31，P<0.00001），免疫球蛋白G（IgG）水平升高（MD = 1.24，95%CI：0.82 - 1.67，P<0.00001），血清肌酐（Scr）降低（MD = - 12.60，95%CI： - 21.97至 - 3.24，P = 0.008），以及C反应蛋白（CRP）等炎症指标降低（SMD = - 1.67，95%CI： - 2.43至 - 0.90，P<0.0001）。
尽管不常规推荐补充Gln，但它对SAP患者有益。实际上，谷氨酰胺营养对某些指标结局影响不大，但有助于改善该患者群体的预后。国际前瞻性系统评价注册库（PROSPERO，网址：york.ac.uk）。唯一标识符：CRD42021288371。
