谷氨酰胺双肽对手术后患者结局影响的临床随机对照研究荟萃分析

目的系统评价谷氨酰胺双肽用于营养治疗对外科术后患者临床预后的影响。方法检索中国生物医学文献数据库、Cochrane图书馆、Medline数据库、EMBASE数据库,并由中科院图书馆检索SCI数据库,并鉴定随机对照研究（RCT）的质量。按Jadad质量评分进行评定。用RevMan4．2软件进行荟萃分析。结果1074篇相关文献中,共13个随机对照研究符合全部纳入标准。感染率：纳入10个研究。谷氨酰胺双肽显著减少感染有关并发症。合并RR值为0．42,95％CI为0．24～0．72,P=0．002。术后住院时间：纳入8个研究。合并加权均数差值为-3．25d,95％CI为-4．87～-1．62,P=0．00009。表明研究组较对照组住院时间平均缩短3．25d。结论谷氨酰胺双肽用于外科术后患者的肠外营养可以降低外科患者感染风险．缩短件院时间。

The clinical efficacy of glutamine dipeptides on postoperative patients: an updated systematic review of randomized controlled trials from Europe and Asia (1997 - 2005)

OBJECTIVE: To examine the effects of parenteral supplementation of glutamine dipeptide on the outcomes of surgical patients. METHODS: The relevant data 1997 to March or May 2005 were retrieved from SCI, Medline, EMBASE, Chinese Cochrane Centre databases. The bibliographies of the retrieved papers and the personal file were searched as well. All the patients in the retrieved papers received parenteral nutrition, whether alanyl-glutamine dipeptide (Ala-Gln) was added was the only difference between the intervention and control groups. Methodological quality assessment was based on the Cochrane Reviewers' Handbook and Jadad's Score Scale. Statistical software RevMan4.2 was used for meta-analysis. The data were treated by intention-to-treat method. RESULTS: A total of 1074 relevant papers were screened. Thirteen prospective randomized controlled clinical trials (RCTs) from European & Asian studies met the inclusion criteria. Ten RCTs reported 355 cases of infectious complications showed that Ala-Gln administration significantly reduced the prevalence of infectious complications with a pooled relative risk (RR) of 0.42 (95% CI 0.24 - 0.72; P = 0.002). Eight studies with 273 cases reported the postoperative length of stay (LOS) and showed that Ala-Gln significantly reduced the postoperative LOS by 3.25 days (95% CI = -4.87 to -1.62; P = 0.00009). There was no significant effect of Ala-Gln on cost of hospitalization, though there was a trend to reduction (2 studies, pooled n = 52, P = 0.2). CONCLUSION: Parenteral Ala-Gln significantly reduces the post-operative infectious morbidity and LOS among surgical patients.