丙氨酰-谷氨酰胺双肽治疗重症急性胰腺炎的Meta分析_《中国循证医学杂志》

作者：

王燕萍 ¹ , 焦凯 ¹ , 李德邦 ² , 董春禄 ² , 武新安 ¹ ,  刘晓菊 ³

1. 兰州大学第一医院药剂科（兰州 730000）；2. 兰州大学第一医院普外科（兰州 730000）3. 兰州大学第一医院呼吸科（兰州 730000）;

关键词：

丙氨酰-谷氨酰胺双肽重症急性胰腺炎 Meta分析系统评价随机对照试验

DOI：

10.7507/1672-2531.20130192

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价丙氨酰-谷氨酰胺（Ala-Gln）双肽治疗重症急性胰腺炎患者（SAP）的疗效及安全性。
方法　计算机检索MEDLINE、EMbase、CENTRAL、VIP、WanFang Data、CBM和CNKI数据库，检索时限均为从建库至2012年10月，收集Ala-Gln双肽治疗SAP的随机对照试验（RCT）。由两位研究者按照纳入与排除标准独立进行文献筛选、资料提取和评价纳入研究的方法学质量后，采用 RevMan 5.2软件进行 Meta 分析。
结果　最终纳入5个RCT，共227例患者。Meta分析结果显示：在常规治疗的基础上加用Ala-Gln双肽组与对照组比较，可降低SAP并发症发生率［RR=0.41，95%CI（0.20，0.82）］、胰腺坏死性感染发生率［RR=0.12，95%CI（0.02，0.89）］，缩短腹胀缓解时间［MD= –0.90，95%CI（–1.72，–0.08）］，且有降低SAP病死率［RR=0.15，95%CI（0.02，1.19）］和缩短血淀粉酶恢复时间［SMD=0.37，95%CI（–0.04，0.79）］的趋势。
结论　现有临床研究证据显示，SAP患者使用Ala-Gln双肽与传统治疗比较，在降低并发症发生率、胰腺坏死性感染发生率，缩短腹胀缓解时间等方面有显著优势。由于纳入研究质量均较低，上述结论尚需更多高质量研究验证。

引用本文： 王燕萍,焦凯,李德邦,董春禄,武新安,刘晓菊. 丙氨酰-谷氨酰胺双肽治疗重症急性胰腺炎的Meta分析. 中国循证医学杂志, 2013, 13(9): 1123-1128. doi: 10.7507/1672-2531.20130192 复制

1.	Xue P, Deng LH, Xia Q, et al. Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage. World J Gastroenterol, 2008, 14(3): 474-478.
2.	Novak F, Heyland DK, Avenell A, et al. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med, 2002, 30(4): 2022-2029.
3.	Ziegler TR, Bazargan N, Leader LM, et al. Glutamine and the gastrointestinal tract. Curr Opin Clin Nutr Metab Care, 2000, (3): 355-362.
4.	Nathens AB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis. Crit Care Med, 2004, 32(3): 2524-2536.
5.	Ikeda S, Kudsk KA, Le T, et al. Glutamine improves impaired cellular exudation and polymorphonuclear neutrophil phagocytosis induced by total parenteral nutrition after glycogen-induced murine peritonitis. Shock, 2003, 19(4): 50-54.
6.	Wischmeyer PE, Musch MW, Madonna MB, et al. Glutamine protects intestinal epithelial cells: role of inducible HSP70. Am J Physiol, 1997, 272: G879-G884.
7.	Gloor B, Muller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg, 2001, 88(2): 975-979.
8.	Wischmeyer PE, Kahana M, Wolfson R, et al. Glutamine induces heat shock protein and protects against endotoxin shock in the rat. J Appl Physiol, 2001, 90(4): 2403-2410.
9.	Houdijk AP, Rijnsburger ER, Jansen J, et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet, 1998, 352(4): 772-776.
10.	Exner R, Weingartmann G, Eliasen MM, et al. Glutamine deficiency renders human monocytic cells more susceptible to speciﬁ c apoptosis triggers. Surgery, 2002, 131(2): 75-80.
11.	McCauley R, Kong SE, Hall J. Glutamine and nucleotide metabolism within enterocytes. JPEN J Parenter Enteral Nutr, 1998, 22(3): 105-111.
12.	Moﬁdi R, Madhavan KK, Garden OJ, et al. An audit of the management of patients with acute pancreatitis against national standards of practice. Br J Surg, 2007, 94(4): 844-848.
13.	Zheng YM, Li F, Zhang MM, et al. Glutamine dipeptide for parenteral nutrition in abdominal surgery: a meta-analysis of randomized controlled trials. World J Gastroenterol, 2006, 12(6): 7537-7541.
14.	Peng YL, Gong QF, Wand ZQ. The prospective study on application of parenteral nutrition with alanyl-glutamine dipeptide in chemotherapy of gastrointestinal neoplasms patients. Ai Zheng, 2006, 25(12): 1044-1047.
15.	Dechelotte P, Hasselmann M, Cynober L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. Crit Care Med, 2006, 34(8): 598-604.
16.	赵慧敏, 黄茜. 丙氨酰-谷氨酰胺防治重症急性胰腺炎肠功能衰竭的临床研究. 临床合理用药, 2010, 3(11): 44-45.
17.	黄晓东, 黄慧. 丙氨酰-谷氨酰胺双肽在重症急性胰腺炎中的应用. 现代诊断与治疗, 2010, 21(6): 342-343.
18.	王湛, 黄圣旺, 刘培, 等. 全胃肠外营养联合谷氨酰胺二肽对重症胰腺炎患者非手术治疗的意义. 实用预防医学, 2009, 16(3): 844-846.
19.	何安彬, 陈绍鹏, 杨莉, 等. 重症急性胰腺炎应用丙氨酰-谷氨酰胺后的治疗观察. 医学信息, 2011, 24(9): 6070-6071.
20.	He XL, Ma QJ, Lu JG, et al. Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supp lementati on outcome in severe acute pancreatitis (SAP). Clinical Nutrition Supplements, 2004, 1: 43-47.
21.	Wischmeyer PE, Riehm J, Singleton KD, et al. Glutamine attenuates tumor necrosis factor-alpha release and enhances heat shock protein 72 in human peripheral blood mononuclear cells. Nutrition, 2003, 19(4): 1-6.
22.	Ockenga J, Borchert K, Rifai K, et al. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis. Clin Nutr, 2002, 21(5): 409-416.

1. Xue P, Deng LH, Xia Q, et al. Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage. World J Gastroenterol, 2008, 14(3): 474-478.
2. Novak F, Heyland DK, Avenell A, et al. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med, 2002, 30(4): 2022-2029.
3. Ziegler TR, Bazargan N, Leader LM, et al. Glutamine and the gastrointestinal tract. Curr Opin Clin Nutr Metab Care, 2000, (3): 355-362.
4. Nathens AB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis. Crit Care Med, 2004, 32(3): 2524-2536.
5. Ikeda S, Kudsk KA, Le T, et al. Glutamine improves impaired cellular exudation and polymorphonuclear neutrophil phagocytosis induced by total parenteral nutrition after glycogen-induced murine peritonitis. Shock, 2003, 19(4): 50-54.
6. Wischmeyer PE, Musch MW, Madonna MB, et al. Glutamine protects intestinal epithelial cells: role of inducible HSP70. Am J Physiol, 1997, 272: G879-G884.
7. Gloor B, Muller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg, 2001, 88(2): 975-979.
8. Wischmeyer PE, Kahana M, Wolfson R, et al. Glutamine induces heat shock protein and protects against endotoxin shock in the rat. J Appl Physiol, 2001, 90(4): 2403-2410.
9. Houdijk AP, Rijnsburger ER, Jansen J, et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet, 1998, 352(4): 772-776.
10. Exner R, Weingartmann G, Eliasen MM, et al. Glutamine deficiency renders human monocytic cells more susceptible to speciﬁ c apoptosis triggers. Surgery, 2002, 131(2): 75-80.
11. McCauley R, Kong SE, Hall J. Glutamine and nucleotide metabolism within enterocytes. JPEN J Parenter Enteral Nutr, 1998, 22(3): 105-111.
12. Moﬁdi R, Madhavan KK, Garden OJ, et al. An audit of the management of patients with acute pancreatitis against national standards of practice. Br J Surg, 2007, 94(4): 844-848.
13. Zheng YM, Li F, Zhang MM, et al. Glutamine dipeptide for parenteral nutrition in abdominal surgery: a meta-analysis of randomized controlled trials. World J Gastroenterol, 2006, 12(6): 7537-7541.
14. Peng YL, Gong QF, Wand ZQ. The prospective study on application of parenteral nutrition with alanyl-glutamine dipeptide in chemotherapy of gastrointestinal neoplasms patients. Ai Zheng, 2006, 25(12): 1044-1047.
15. Dechelotte P, Hasselmann M, Cynober L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. Crit Care Med, 2006, 34(8): 598-604.
16. 赵慧敏, 黄茜. 丙氨酰-谷氨酰胺防治重症急性胰腺炎肠功能衰竭的临床研究. 临床合理用药, 2010, 3(11): 44-45.
17. 黄晓东, 黄慧. 丙氨酰-谷氨酰胺双肽在重症急性胰腺炎中的应用. 现代诊断与治疗, 2010, 21(6): 342-343.
18. 王湛, 黄圣旺, 刘培, 等. 全胃肠外营养联合谷氨酰胺二肽对重症胰腺炎患者非手术治疗的意义. 实用预防医学, 2009, 16(3): 844-846.
19. 何安彬, 陈绍鹏, 杨莉, 等. 重症急性胰腺炎应用丙氨酰-谷氨酰胺后的治疗观察. 医学信息, 2011, 24(9): 6070-6071.
20. He XL, Ma QJ, Lu JG, et al. Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supp lementati on outcome in severe acute pancreatitis (SAP). Clinical Nutrition Supplements, 2004, 1: 43-47.
21. Wischmeyer PE, Riehm J, Singleton KD, et al. Glutamine attenuates tumor necrosis factor-alpha release and enhances heat shock protein 72 in human peripheral blood mononuclear cells. Nutrition, 2003, 19(4): 1-6.
22. Ockenga J, Borchert K, Rifai K, et al. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis. Clin Nutr, 2002, 21(5): 409-416.

《中国循证医学杂志》

丙氨酰-谷氨酰胺双肽治疗重症急性胰腺炎的Meta分析

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《中国循证医学杂志》

丙氨酰-谷氨酰胺双肽治疗重症急性胰腺炎的Meta分析

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