肠内营养中碳水化合物及脂肪比例对糖尿病患者血糖及感染率的影响:Meta-分析

目的评价肠内营养中不同碳水化合物及脂肪比例对糖尿病患者血糖及感染率的影响。方法检索中国生物医学文献数据库、Cochrane图书馆、Medline光盘数据库,鉴定有关随机对照试验(randomized clinical trial,RCT),采用RevMan4.1统计软件进行Meta-分析。结果纳入4个符合入选标准的研究,比较含不同碳水化合物及脂肪比例的肠内营养(EN)对糖尿病患者血糖及感染率的影响。低碳水化合物高脂肪的EN比高碳水化合物低脂肪的EN,对应激状态糖尿病患者血糖影响的加权均数差值(weighted mean difference,WMD)为-1.47,95％CI为[-3.22,0.27],P=0.10;对感染率影响的相对危险度(Relative Risk,RR)为0.90,95％CI为[0.59,1.39],P=0.60。结论糖尿病患者(尤其在应激状态下)接受低碳水化合物高脂肪的EN(糖尿病适用型)后,血糖较接受高碳水化合物低脂肪普通En的患者有降低倾向;感染率虽有下降趋势,但无统计学差异。

The Impart of Enteral Nutrients Containing Various Ratio of Carbohydrates and Fat on Plasma Glucose Level and Infection Rate of Diabetic Patients: a Meta - analysis.

Objective To systematically review the impact of different enteral nutrients, containing various ratio of carbohydrates and fat, on plasma glucose level and infection rate of diabetic patients. Methods The following electronic databases were retrieved: MEDLTNE, EM-BASE, SCI, Cochrane Library and Chinese Biomedical database. Data were extracted by two reviewers.RevMan 4.1 software was applied for statistical analysis. Results We reviewed 67 titles, abstracts and papers, 4 trials met all the inclusion criteria. When the data of these trials were aggregated, the results showed that the low carbohydrates and high fat containing EN had a tendency for glycemic control comparing with high carbohydrates and low fat containing EN on diabetic patients especially under stress: weighted mean difference (WMD) was - 1.47, 95 % CI was ( - 3.22, 0.27) , P= 0.10; tended to have a decreased infection rate although not statistically different, relative risk (RR) was 0.90, 95 % CI was [0.59, 1.39], P=0.60. Conclusions Low carbohydrates and high fat containing EN had a tendency for better glycemic control comparing with high carbohydrates and low fat containing EN on diabetic patients especially under stress, tended to have a decreased infection rate although not statistically different.