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

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。

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

ObjectiveTo evaluate the immunonutrition function and clinical outcomes of glutamine-supplemented parenteral nutrition treatment on critically ill patients. MethodsRandomized 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. ResultsA 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 stayWMD=-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. ConclusionParenteral glutamine supplementation can not improve the clinical outcomes of critically ill patients.