丙氨酰-谷氨酰胺雙肽治療重癥急性胰腺炎的Meta分析_《中國循證醫學雜志》

作者：

王燕萍 ¹ , 焦凱 ¹ , 李德邦 ² , 董春祿 ² , 武新安 ¹ ,  劉曉菊 ³

1. 蘭州大學第一醫院藥劑科（蘭州 730000）；2. 蘭州大學第一醫院普外科（蘭州 730000）3. 蘭州大學第一醫院呼吸科（蘭州 730000）;

關鍵詞：

丙氨酰-谷氨酰胺雙肽重癥急性胰腺炎 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130192

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目的　系統評價丙氨酰-谷氨酰胺（Ala-Gln）雙肽治療重癥急性胰腺炎患者（SAP）的療效及安全性。
方法　計算機檢索MEDLINE、EMbase、CENTRAL、VIP、WanFang Data、CBM和CNKI數據庫，檢索時限均為從建庫至2012年10月，收集Ala-Gln雙肽治療SAP的隨機對照試驗（RCT）。由兩位研究者按照納入與排除標準獨立進行文獻篩選、資料提取和評價納入研究的方法學質量后，采用 RevMan 5.2軟件進行 Meta 分析。
結果　最終納入5個RCT，共227例患者。Meta分析結果顯示：在常規治療的基礎上加用Ala-Gln雙肽組與對照組比較，可降低SAP并發癥發生率［RR=0.41，95%CI（0.20，0.82）］、胰腺壞死性感染發生率［RR=0.12，95%CI（0.02，0.89）］，縮短腹脹緩解時間［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）］和縮短血淀粉酶恢復時間［SMD=0.37，95%CI（–0.04，0.79）］的趨勢。
結論　現有臨床研究證據顯示，SAP患者使用Ala-Gln雙肽與傳統治療比較，在降低并發癥發生率、胰腺壞死性感染發生率，縮短腹脹緩解時間等方面有顯著優勢。由于納入研究質量均較低，上述結論尚需更多高質量研究驗證。

引用本文： 王燕萍,焦凱,李德邦,董春祿,武新安,劉曉菊. 丙氨酰-谷氨酰胺雙肽治療重癥急性胰腺炎的Meta分析. 中國循證醫學雜志, 2013, 13(9): 1123-1128. doi: 10.7507/1672-2531.20130192 復制

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 speci? 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.	Mo?di 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.	趙慧敏, 黃茜. 丙氨酰-谷氨酰胺防治重癥急性胰腺炎腸功能衰竭的臨床研究. 臨床合理用藥, 2010, 3(11): 44-45.
17.	黃曉東, 黃慧. 丙氨酰-谷氨酰胺雙肽在重癥急性胰腺炎中的應用. 現代診斷與治療, 2010, 21(6): 342-343.
18.	王湛, 黃圣旺, 劉培, 等. 全胃腸外營養聯合谷氨酰胺二肽對重癥胰腺炎患者非手術治療的意義. 實用預防醫學, 2009, 16(3): 844-846.
19.	何安彬, 陳紹鵬, 楊莉, 等. 重癥急性胰腺炎應用丙氨酰-谷氨酰胺后的治療觀察. 醫學信息, 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 speci? 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. Mo?di 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. 趙慧敏, 黃茜. 丙氨酰-谷氨酰胺防治重癥急性胰腺炎腸功能衰竭的臨床研究. 臨床合理用藥, 2010, 3(11): 44-45.
17. 黃曉東, 黃慧. 丙氨酰-谷氨酰胺雙肽在重癥急性胰腺炎中的應用. 現代診斷與治療, 2010, 21(6): 342-343.
18. 王湛, 黃圣旺, 劉培, 等. 全胃腸外營養聯合谷氨酰胺二肽對重癥胰腺炎患者非手術治療的意義. 實用預防醫學, 2009, 16(3): 844-846.
19. 何安彬, 陳紹鵬, 楊莉, 等. 重癥急性胰腺炎應用丙氨酰-谷氨酰胺后的治療觀察. 醫學信息, 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.

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《中國循證醫學雜志》

丙氨酰-谷氨酰胺雙肽治療重癥急性胰腺炎的Meta分析

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