支链氨基酸对创伤患者代谢及预后影响的Meta分析

目的系统评价支链氨基酸对创伤患者代谢及预后的影响,为临床治疗提供循证参考。方法通过计算机网上检索Medline、Cochrane、EMbase、CNKI、万方以及维普数据库,收集支链氨基酸对创伤患者代谢及预后影响的随机对照试验(randomized controlled trial,RCT),对纳入研究进行质量评价和提取后,采用Rev Man 5.3统计软件对同质性结果进行合并分析。结果共纳入13项符合标准的随机对照试验相关文献,合计656例患者。Meta分析显示,与平衡氨基酸相比,创伤患者术后给予支链氨基酸能更好地改善氮平衡MD=7.24,95%CI(5.16,9.32),P0.01],提高总蛋白水平MD=1.06,95%CI(0.21,1.90),P=0.01]和白蛋白水平MD=1.90,95%CI(1.27,2.54),P0.01],减少术后并发症OR=0.32,95%CI(0.15,0.68),P0.01]。结论支链氨基酸对创伤患者代谢有着积极的作用,但对预后的影响有待进一步研究证实。

Effect of branched chain amino acids on metabolism and prognosis of traumatic patients: Meta analysis

Objective To evaluate the metabolic and prognosis effects of branched chain amino acids on traumatic patients,so as to provide evidence-based reference for clinical treatment.Methods Through retrieving data from Medline,Cochrane Library,EMbase,CNKI,and Wanfang Database,randomized controlled trials(RCTs)about the effect of branched chain amino acids on metabolism and prognosis of traumatic patients were collected,and meta analysis was conducted by using Rev Man 5.3 statistical software after evaluating the quality of included studies and extracting the data.Results A total of 13 RCTs were included,involving 656 patients.Meta analysis showed that the nitrogen balanceMD=7.24,95％CI(5.16,9.32),P＜0.01],level of total proteinMD=1.06,95％CI(0.21,1.90),P=0.01],level of albuminMD=1.90,95％CI(1.27,2.54),P＜0.01],and the complicationOR=0.32,95％CI(0.15,0.68),P＜0.01]in patients given branched chain amino acid were significantly better than those in patients given balanced amino ascid.Conclusion The branched chain amino acids may be more suitable and effective for the postoperative traumatic patients on protein metabolism.Due to the limited research about the prognosis effect,more high-quality and large-scale long-term RCTs are required for further validation of the conclusion.