切换至 "中华医学电子期刊资源库"
高级检索
中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (01) : 41 -48. doi: 10.3877/cma.j.issn.1674-6880.2018.01.007

所属专题： 文献；

荟萃分析

谷氨酰胺强化肠外营养支持对重症患者临床结局影响的Meta分析
何晓玮1, 鲁晟1, 钟涛2, 徐巍3, 严冰1, 吴飞连1, 邱丽1, 何昱4, 唐坎凯3,†()   
  1. 1. 313000　浙江湖州，湖州师范学院附属第一医院药剂科
    2. 313000　浙江湖州，浙北明州医院药剂科
    3. 313000　浙江湖州，湖州师范学院附属第一医院重症医学科
    4. 310053　杭州，浙江中医药大学药学院
  • 收稿日期:2017-04-13 出版日期:2018-02-01
  • 通信作者: 唐坎凯
  • 基金资助:
    国家自然科学基金项目(81373898); 浙江省医药一般项目(2016KYB279); 湖州市科技计划项目(2017GYB03)

Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis

Xiaowei He1, Sheng Lu1, Tao Zhong2, Wei Xu3, Bing Yan1, Feilian Wu1, Li Qiu1, Yu He4, Kankai Tang3,†()   

  1. 1. Department of Pharmacy, First Affiliated Hospital, Huzhou University, Huzhou 313000, China
    2. Department of Pharmacy, Zhebei Mingzhou Hospital, Huzhou 313000, China
    3. Department of Intensive Care Unit, First Affiliated Hospital, Huzhou University, Huzhou 313000, China
    4. College of pharmacy, Zhejiang Chinese Medical University, Hangzhou 310053, China
  • Received:2017-04-13 Published:2018-02-01
  • Corresponding author: Kankai Tang
  • About author:
    Corresponding author: Tang Kankai, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

何晓玮, 鲁晟, 钟涛, 徐巍, 严冰, 吴飞连, 邱丽, 何昱, 唐坎凯. 谷氨酰胺强化肠外营养支持对重症患者临床结局影响的Meta分析[J]. 中华危重症医学杂志(电子版), 2018, 11(01): 41-48.

Xiaowei He, Sheng Lu, Tao Zhong, Wei Xu, Bing Yan, Feilian Wu, Li Qiu, Yu He, Kankai Tang. Effect of parenteral glutamine supplementation on clinical outcomes in critical ill patients: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(01): 41-48.

目的

系统评价谷氨酰胺强化肠外营养支持治疗对重症患者免疫营养功能及临床结局的影响。

方法

检索Embase、Medline、Cochrane Central Register of Controlled Trials、The Cochrane Database of Systematic Reviews、中国期刊全文数据库、维普中文科技期刊全文数据库、万方数据库及中国生物医学文献数据库自建库至2016年12月期间研究常规肠外营养（常规组）与谷氨酰胺强化肠外营养（干预组）支持治疗对ICU重症患者病死率、感染发生率及住院时间等临床结局影响的随机对照试验。由2名研究者按照纳入及排除标准独立进行文献筛选、提取和质量评估后，使用Review Manager 5.2.0分析软件进行Meta分析。

结果

共纳入18项随机对照试验，包括1 708例患者。Meta分析结果显示，应用谷氨酰胺强化的肠外营养，可以显著降低重症患者住院病死率[RR=0.63，95%CI（0.47，0.84），Z=3.16，P=0.002]，但两组间ICU病死率[RR=1.00，95%CI（0.83，1.22），Z=0.04，P=0.97]、6个月病死率[RR=0.95，95%CI（0.67，1.34），Z=0.29，P=0.77]比较，差异均无统计学意义；且肺部感染发生率[RR=0.91，95%CI（0.62，1.32），Z=0.52，P=0.61]、尿路感染发生率[RR=0.79，95%CI（0.37，1.67），Z=0.62，P=0.54]、菌血症[RR=0.52，95%CI（0.21，1.33），Z=1.36，P=0.18]、导管相关感染[RR=0.69，95%CI（0.32，1.49），Z=0.95，P=0.34]及其他感染[RR=0.94，95%CI（0.80，1.10），Z=0.81，P=0.42]比较，差异亦均无统计学意义；同时，两组患者间住院时间[WMD=-0.26，95%CI（-3.81，3.28），Z=0.15，P=0.88]及住ICU时间[WMD=-1.04，95%CI（3.95，1.87），Z=0.70，P=0.48]比较，差异均无统计学意义。

结论

使用谷氨酰胺强化的肠外营养支持疗法不能改善重症患者临床结局。

关键词: 谷氨酰胺, 胃肠外营养, Meta分析, 重症
Objective

To evaluate the immunonutrition function and clinical outcomes of glutamine-supplemented parenteral nutrition treatment on critically ill patients.

Methods

Randomized controlled trials which focused on clinical outcomes (like the mortality, the infection rate and the length of stay) of converntional parenteral nutrition treatment (the control group) and glutamine-supplemented parenteral nutrition treatment (the glutamine group) on critically ill patients were systematically retrieved from Embase, Medline, Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, CNKI database, CQVIP database, Wan Fang database and CMB databases from their inception to December 2016. Included articles were independently screened, extracted and evaluated by two reviewers according to the inclusion and exclusion criteria and then conducted the meta-analysis by RevMan 5.2.0.

Results

A total of 1 708 patients in 18 studies were included. Meta-analysis showed that the hospital mortality in the glutamine group was much lower than that in the control group [RR=0.63, 95%CI (0.47, 0.84), Z=3.16, P=0.002]. However, there were no significant differences in the ICU mortality [RR=1.00, 95%CI (0.83, 1.22), Z=0.04, P=0.97], 6-month mortality [RR=0.95, 95%CI (0.67, 1.34), Z=0.29, P=0.77], pulmonary infection [RR=0.91, 95%CI (0.62, 1.32), Z=0.52, P=0.61], urinary tract infection [RR=0.79, 95%CI (0.37, 1.67), Z=0.62, P=0.54], bacteremia [RR=0.52, 95%CI (0.21, 1.33), Z=1.36, P=0.18], catheter-related infection [RR=0.69, 95%CI (0.32, 1.49), Z=0.95, P=0.34], and other infections [RR=0.94, 95%CI (0.80, 1.10), Z=0.81, P=0.42] between the two groups. The hospital length of stay[WMD=-0.26, 95%CI (-3.81, 3.28), Z=0.15, P=0.88] and ICU length of stay [WMD=-1.04, 95%CI (3.95, 1.87), Z=0.70, P=0.48] also showed no significant differences between the two groups.

Conclusion

Parenteral glutamine supplementation can not improve the clinical outcomes of critically ill patients.

Key words: Glutamine, Parenteral nutrition, Meta-analysis, Critically ill
表1 纳入18篇随机对照研究的基本特征
文献 国别 病例数（干预组/常规组） 谷氨酰胺给药方式 结局指标 Jadad评分（分）
Griffiths等1997[7] 英国 42/42 肠外营养 ①②③ 5
Poweel-Tuck等1999[8] 英国 83/85 肠外营养 ①③ 4
Goeters等2002[9] 德国 33/35 静脉注射 ①③ 3
Fuentes-Orozco等2004[10] 墨西哥 17/16 肠外营养 ①②③ 2
Dechelotte等2006[11] 法国 58/56 肠外营养 ①②③ 5
Sahin等2007[12] 土耳其 20/20 肠外营养 ①③ 2
Fuentes-Orozco等2008[13] 墨西哥 22/22 肠外营养 ①②③ 4
Duska等2008[14] 捷克 10/10 肠外营养 ① 4
Estivariz等2008[15] 美国 32/31 肠外营养 ①②③ 5
Perez-Barcena等2010[16] 西班牙 23/20 肠外营养 ①②③ 3
Cekman等2011[17] 土耳其 15/15 肠外营养 ①③ 5
Grau等2011[18] 西班牙 59/68 肠外营养 ①②③ 4
Andrew等2011[19] 苏格兰 250/252 肠外营养 ①②③ 5
Ziegler等2013[20] 美国 75/75 肠外营养 ①②③ 5
Zhao等2013[21] 中国 40/40 静脉注射 ①②③ 4
Perez-Barcena等2014[22] 西班牙 71/71 静脉注射 ①②③ 5
图1 谷氨酰胺强化肠外营养对重症患者住院病死率影响的森林图
图2 谷氨酰胺强化肠外营养对重症患者ICU病死率影响的森林图
图3 谷氨酰胺强化肠外营养对重症患者6个月病死率影响的森林图
图4 谷氨酰胺强化的肠外营养对重症患者感染发生率影响的森林图
图5 谷氨酰胺强化的肠外营养对重症患者住院时间影响的森林图
图6 谷氨酰胺强化肠外营养对重症患者住ICU时间影响的森林图
[1]
Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients[J]. N Engl J Med, 2013, 368 (16): 1489-1497.
[2]
Oudemanss-van Straaten HM, Bosman RJ, Treskes M, et al. Plasma glutamine depletion and patient outcome in acute ICU admissions[J]. Intensive Care Med, 2001, 27 (1): 84-90.
[3]
Bollhalder L, Pfeil AM, Tomonaga Y, et al. A syste-matic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation[J]. Clin Nutr, 2013, 32 (2): 213-223.
[4]
Wernerman J. How to understand the results of stu-dies of glutamine supplimentation[J]. Crit Care, 2015 (19): 385.
[5]
潘小东，汤鲁明，孙来芳.危重神经系统疾病患者肠内营养与胃内营养对预后影响的Meta分析[J/CD].中华危重症医学杂志（电子版），2015，8（1）：29-34.
[6]
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17 (1): 1-12.
[7]
Griffiths RD, Allen KD, Andrews FJ, et al. Infection, multiple organ failure, and survival in the intensive care unit: influence of glutamine-supplemented parenteral nutrition on acquired infection[J]. Nutrition, 2002, 18 (7-8): 546-552.
[8]
Powell-Tuck J, Jamieson CP, Bettany GE, et al. A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition[J]. Gut, 1999, 45 (1): 82-88.
[9]
Goeters C, Wenn A, Mertes N, et al. Parenteral L-alanyl-L-glutamine improves 6-month outcome in cretically ill patients[J]. Crit Care Med, 2002, 30 (9): 2032-2037.
[10]
Fuentes-Orozco C, Anaya-Prado R, Gonzalez-Ojeda A, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis[J]. Clin Nutr, 2004, 23 (1): 13-21.
[11]
Dechelotte P, Hasselmann M, Cynober L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study[J]. Crit Care Med, 2006, 34 (3): 598-604.
[12]
Sahin H, Mercanligil SM, Inanc N, et al. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis[J]. Eur J Clin Nutr, 2007, 61 (12): 1429-1434.
[13]
Fuentes-Orozco C, Cervantes-Guevara G, Mucino-Hern-andez I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis[J]. J Parenter Enteral Nutr, 2008, 32 (4): 403-411.
[14]
Duska F, Fric M, Waldauf P, et al. Frequent intra-venous pulses of growth hormone together with glutamine supplementation in prolonged critical illness after multiple trauma: effects on nitrogen balance, insulin resistance, and substrate oxidation[J]. Crit Care Med, 2008, 36 (6): 1707-1713.
[15]
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients[J]. J Parenter Enteral Nutr, 2008, 32 (4): 389-402.
[16]
Perez-Barcena J, Crespi C, Regueiro V, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Crit Care, 2010, 14 (6): R233.
[17]
Cekmen N, Aydin A, Erdemli O. The impact of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on clinical outcome in critically patients[J]. E-SPEN, Euro e-J Clin Nutr Metab, 2011, 6 (2): e64-e67.
[18]
Grau T, Bonet A, Minambres E, et al. The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients[J]. Crit Care Med, 2011, 39 (6): 1263-1268.
[19]
Andrews PJ, Avenell A, Noble DW, et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients[J]. BMJ, 2011 (342): d1542.
[20]
Ziegler T, May A, Hebbar G, et al. LB001-mon glutamine dipeptide-supplemented parenteral nutrition in surgical ICU patients: results of an American randomized, double-blind, multicenter trial[J]. Clin Nutr Suppl, 2012, 7 (1): 265.
[21]
Zhao G, Zhang JG, Wu HS, et al. Effects of different resuscitation fluid on severe acute pancreatitis[J]. World J Gastroenterol, 2013, 19 (13): 2044-2052.
[22]
Perez-Barcena J, Marse P, Zabalegui-Perez A, et al. A randomized trial of intravenous glutamine supplementation in trauma ICU patients[J]. Intensive Care Med, 2014, 40 (4): 539-547.
[23]
Yeh DD, Fuentes E, Quraishi SA, et al. Adequate nutrition may get you home: effect of caloric/protein deficits on the discharge destination of critically ill surgical patients[J]. JPEN J Parenter Enteral Nutr,2016, 40 (1): 37-44.
[24]
Choi EY, Park DA, Park J. Calorie intake of enteral nutrition and clinical outcomes in acutely critically ill patients: a meta-analysis of randomized controlled trials[J]. J Parenter Enteral Nutr, 2015, 39 (3): 291-300.
[25]
Nienaber A, Dolman RC, van Graan AE, et al. Pre-valence of glutamine deficiency in ICU patients: a cross-sectional analytical study[J]. Nutr J, 2016, 15 (1): 73.
[26]
van Zanten AR, Dhaliwal R, Garrel D, et al. Enteral glutamine supplementation in critically ill patients: systematic review and meta-analysis[J]. Crit Care, 2015 (19): 294.
[27]
Chen QH, Yang Y, He HL, et al. The effect of glutamine therapy on outcomes in critically ill patients: a meta-analysis of randomized controlled trials[J]. Crit Care, 2014, 18 (1): R8.
[28]
Rodas PC, Rooyackers O, Hebert C, et al. Glutamine and glutathione at ICU admission in relation to outcome[J]. Clin Sci (Lond), 2012, 122 (12): 591-597.
[29]
王松志，吴乐军，吴应虬，等.谷氨酰胺强化肠外营养对全身炎症反应综合征患者影响的临床研究[J].中国临床药理学杂志，2015，31（8）：618-620，634.
[30]
Pérez-Bárcena J, Crespí C, Regueiro V, et al. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit[J]. Crit Care, 2010, 14 (6): R233.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[3] 马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[4] 徐娟, 孙汝贤, 赵东亚, 张清艳, 金兆辰, 蔡燕. 右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 363-369.
[5] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[6] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[7] 黄翠君, 张喜玲, 刘思嘉, 刘云建. 重症急性胰腺炎营养支持治疗研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(05): 385-390.
[8] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[9] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[10] 江文诗, 何湘湘. 全球及我国器官捐献发展特征分析与学科建设[J]. 中华移植杂志(电子版), 2023, 17(05): 280-286.
[11] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[12] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[13] 王小红, 钱晶, 翁文俊, 周国雄, 朱顺星, 祁小鸣, 刘春, 王萍, 沈伟, 程睿智, 秦璟灏. 巯基丙酮酸硫基转移酶调控核因子κB信号介导自噬对重症急性胰腺炎大鼠的影响及机制[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 422-426.
[14] 马强, 李军, 苟丽娟. 重症急性胰腺炎miR-21-3p、RUNX3表达水平及对病情发展程度的预测[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 337-341.
[15] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号