中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
7期
525-530
,共6页
重症急性胰腺炎%谷氨酰胺%Meta分析
重癥急性胰腺炎%穀氨酰胺%Meta分析
중증급성이선염%곡안선알%Meta분석
Severe acute pancreatitis%Glutamine%Meta analysis
目的 系统评价谷氨酰胺强化营养支持治疗重症急性胰腺炎(SAP)的疗效.方法 以“glutamine”、“severe acute pancreatitis"、“SAP”、“谷氨酰胺”、“重症急性胰腺炎”等为检索词检索PubMed、Embase、HighWire、Cochrane Central Register of Controlled Trials、万方数据库、中国期刊全文数据库(CJFD)、中国生物医学文献数据库(CBM).检索时间为各数据库建库至2014年3月.最终纳入常规治疗对比谷氨酰胺强化营养支持治疗SAP疗效的随机对照试验,再由2名研究者独立筛查文献和提取数据,并进行文献质量评价,用RevMan 5.2软件进行Meta分析.所纳入研究中SAP的诊断标准为“Atlanta修订标准”或“中华医学会外科学分会胰腺外科学组SAP诊断与治疗指南”.计数资料采用相对危险度(RR)及95％可信区间(95％ CI)进行分析,计量资料采用标准均数差(SMD)及95％CI进行分析.采用I2对异质性进行定量分析.结果 共纳入符合标准的文献10篇,均为前瞻性随机对照研究.累计样本量433例,其中行常规治疗患者218例(对照组),行谷氨酰胺强化营养支持治疗患者215例(实验组).Meta分析结果显示:与对照组比较,实验组SAP患者Alb水平显著升高、C反应蛋白水平显著降低、住院时间显著缩短(SMD=1.00,-0.93,-0.71,95％CI:0.50～1.50,-1.25～-0.61,-1.10～-0.32,P＜0.05),并发症发生率和病死率显著降低(RR =0.56,0.34,95％CI:0.41 ～0.77,0.15～0.76,P＜0.05),且不增加患者住院费用(SMD =0.03,95％CI:-0.88 ～0.95,P＞0.05).结论 谷氨酰胺强化营养支持治疗较常规治疗SAP的疗效具有一定优势.
目的 繫統評價穀氨酰胺彊化營養支持治療重癥急性胰腺炎(SAP)的療效.方法 以“glutamine”、“severe acute pancreatitis"、“SAP”、“穀氨酰胺”、“重癥急性胰腺炎”等為檢索詞檢索PubMed、Embase、HighWire、Cochrane Central Register of Controlled Trials、萬方數據庫、中國期刊全文數據庫(CJFD)、中國生物醫學文獻數據庫(CBM).檢索時間為各數據庫建庫至2014年3月.最終納入常規治療對比穀氨酰胺彊化營養支持治療SAP療效的隨機對照試驗,再由2名研究者獨立篩查文獻和提取數據,併進行文獻質量評價,用RevMan 5.2軟件進行Meta分析.所納入研究中SAP的診斷標準為“Atlanta脩訂標準”或“中華醫學會外科學分會胰腺外科學組SAP診斷與治療指南”.計數資料採用相對危險度(RR)及95％可信區間(95％ CI)進行分析,計量資料採用標準均數差(SMD)及95％CI進行分析.採用I2對異質性進行定量分析.結果 共納入符閤標準的文獻10篇,均為前瞻性隨機對照研究.纍計樣本量433例,其中行常規治療患者218例(對照組),行穀氨酰胺彊化營養支持治療患者215例(實驗組).Meta分析結果顯示:與對照組比較,實驗組SAP患者Alb水平顯著升高、C反應蛋白水平顯著降低、住院時間顯著縮短(SMD=1.00,-0.93,-0.71,95％CI:0.50～1.50,-1.25～-0.61,-1.10～-0.32,P＜0.05),併髮癥髮生率和病死率顯著降低(RR =0.56,0.34,95％CI:0.41 ～0.77,0.15～0.76,P＜0.05),且不增加患者住院費用(SMD =0.03,95％CI:-0.88 ～0.95,P＞0.05).結論 穀氨酰胺彊化營養支持治療較常規治療SAP的療效具有一定優勢.
목적 계통평개곡안선알강화영양지지치료중증급성이선염(SAP)적료효.방법 이“glutamine”、“severe acute pancreatitis"、“SAP”、“곡안선알”、“중증급성이선염”등위검색사검색PubMed、Embase、HighWire、Cochrane Central Register of Controlled Trials、만방수거고、중국기간전문수거고(CJFD)、중국생물의학문헌수거고(CBM).검색시간위각수거고건고지2014년3월.최종납입상규치료대비곡안선알강화영양지지치료SAP료효적수궤대조시험,재유2명연구자독립사사문헌화제취수거,병진행문헌질량평개,용RevMan 5.2연건진행Meta분석.소납입연구중SAP적진단표준위“Atlanta수정표준”혹“중화의학회외과학분회이선외과학조SAP진단여치료지남”.계수자료채용상대위험도(RR)급95％가신구간(95％ CI)진행분석,계량자료채용표준균수차(SMD)급95％CI진행분석.채용I2대이질성진행정량분석.결과 공납입부합표준적문헌10편,균위전첨성수궤대조연구.루계양본량433례,기중행상규치료환자218례(대조조),행곡안선알강화영양지지치료환자215례(실험조).Meta분석결과현시:여대조조비교,실험조SAP환자Alb수평현저승고、C반응단백수평현저강저、주원시간현저축단(SMD=1.00,-0.93,-0.71,95％CI:0.50～1.50,-1.25～-0.61,-1.10～-0.32,P＜0.05),병발증발생솔화병사솔현저강저(RR =0.56,0.34,95％CI:0.41 ～0.77,0.15～0.76,P＜0.05),차불증가환자주원비용(SMD =0.03,95％CI:-0.88 ～0.95,P＞0.05).결론 곡안선알강화영양지지치료교상규치료SAP적료효구유일정우세.
Objective To systematically review the efficacy of glutamine enriched nutrition support for patients with severe acute pancreatitis (SAP).Methods Database including PubMed,Embase,HighWire,Cochrane Central Register of Controlled Trials,Wanfang Database,CJFD and CBM were searched with "glutamine","severe acute pancreatitis","SAP","谷氨酰胺","重症急性胰腺炎".Literatures published before March 2014 were searched.Randomized controlled trials containing the comparison of conventional treatment and glutamine enriched nutrition support were enrolled in the study,and then the literatures were screened and the data were extracted by 2 independent reviewers.The quality of the literatures was assessed,and the data were analyzed using the RevMan 5.2 software.SAP was diagnosed according to "The revised Atlanta classificantion for acute pancreatitis" or "guideline for the diagnosis and treatment of SAP" which was composed by the pancreatic surgery Branch of Chinese Medical Association.The count data were analyzed using the relative risk (RR) and 95％ confidence interval (95％ CI),and the measurement data were analyzed using standard mean difference (SMD) and 95 ％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Ten literatures including 433 cases were enrolled in the study,and all of them were prospective randomized controlled studies.There were 218 patients treated by conventional methods (control group) and 215 patients received glutamine enriched nutrition support (experimental group).Compared with the control group,glutamine enriched nutrition support could elevate the albumin level,decrease the C-reaction protein level and shorten the hospital stay in the experimental group (SMD=1.00,-0.93,-0.71,95％CI:0.50-1.50,-1.25--0.61,-1.10--0.32,P＜0.05),glutamine enriched nutrition support could decrease the morbidity and mortality (RR =0.56,0.34,95％ CI:0.41-0.77,0.15-0.76,P ＜ 0.05) without increasing the expenses (SMD =0.03,95％ CI:-0.88-0.95,P ＞ 0.05).Conclusion Glutamine enriched nutrition support is superior to conventional methods for the treatment of SAP.
