Efficacy of glutamine-enriched enteral feeding formulae in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

谷氨酰胺强化的肠内营养配方对危重症患者的疗效：随机对照试验的系统综述和meta分析

Azadeh Mottaghi ； Maryam Zarif Yeganeh ； Mahdieh Golzarand ； Sara Jambarsang ； Parvin Mirmiran

《Asia Pacific Journal of Clinical Nutrition》 25卷3期 (2016/09) Pp. 504-512

https://doi.org/10.6133/apjcn.092015.24

摘要

重症患者通常患有代谢应激可以导致营养不良，因此营养支持对保持瘦体重、改善代谢和免疫反应、降低这些病人的死亡率和并发症是必不可少的。本meta分析的目的是评估谷氨酰胺强化的肠内营养对重症患者的疗效。为了获得随机临床试验研究（RCTs），我们检索了MEDLINE和谷歌学术等国际数据库，以及MEDEX、IRANDOC、SID和Magiran等电子资源中2014年12月份以前的文献，不受出版语言限制。最终有10个研究纳入了meta分析。由四个研究者采用包括随机化、盲法和研究对象的合格性三个项目的Jadad5点量表来评估合格研究的方法学质量。我们用STATA12.0分析纳入研究的数据，计算二分类变量的比值比和连续性变量的标准差及它们的95%置信区间（CIs）。死亡率在升高的合并比值比中无显著差异（p-value=0.070）。在绘制漏斗图中没有发表偏倚。固定效应模型显示接受谷氨酰胺强化的肠内营养的患者肠道通透性显著降低（-0.84, 95% CI=-1.25 到-0.44），而且漏斗图显示没有发表偏倚。根据现有的资料，我们的meta 分析表明，肠内谷氨酰胺补充增加死亡率，虽然没有显著性，但显著降低了肠道通透性。

關鍵字

谷氨酰胺 ； 肠内 ； 免疫增强配方 ； 危重症患者 ； 系统综述

並列摘要

Critically ill patients usually suffer from catabolic stress that could lead to malnutrition and nutritional support therefore is essential to maintain lean body mass, improve metabolic and immune response and decrease rate of mortality and comorbidity in these patients. This meta-analysis was aimed to evaluate effect of glutamineenriched enteral nutrition in critically ill patients. In order to obtain randomized clinical trial studies (RCTs), international databases including MEDLINE and Google scholar and also electronic resources in Iran, including IRAN MEDEX, IRAN DOC, SID, Magiran were systematically searched without language and publication restriction before December 2014. The final included number of studies for meta-analysis was 10. The methodological quality of eligible studies was assessed by four investigators using the Jadad 5-point scale, a scale containing three items describing randomization, blinding and fate of participants. We analyzed data from the included studies using STATA version 12.0, and calculated a pooled odds ratio for dichotomous data and mean differences for continuous data with 95% confidence intervals (CIs). There was no significant difference in mortality in elevated pooled odds ratios (p-value=0.070). A funnel plot was drawn for evaluation of publication bias, but none was found. The fixed effect model shows significant reduction in gut permeability in who received enteral feeding enriched with glutamine (-0.84, 95% CI=-1.25 to -0.44), moreover the funnel plot did not show publication bias. Based on the available data, our meta-analysis showed that enteral glutamine (Gln) supplementation increased mortality rate, though non-significantly, but decreased gut permeability significantly.

並列關鍵字

glutamine ； enteral ； immune-enhancing formula ； critically ill patients ； systematic review