Meta-analysis of Glutamine-supplemented Enteral Nutrition in Treatment of Severe Acute Pancreatitis / 胃肠病学

ABSTRACT

Background: Enteral nutrition is an essential component for treatment of severe acute pancreatitis (SAP), yet there is no consensus on whether glutamine should be added in the enteral nutrition. Aims: To systematically evaluate the effect of glutamine-supplemented enteral nutrition on the condition and prognosis of SAP. Methods: Randomized controlled trials (RCT) on the effect of glutamine-supplemented enteral nutrition in the treatment of SAP were retrieved from CNKI, Wanfang, VIP, SinoMed, The Cochrane Library, PubMed, Embase and Web of Science from the date of database foundation to June 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the quality was evaluated and data were extracted. RevMan 5.2 software was used to conduct meta-analysis. Results: A total of 18 RCT involving 1 119 patients were included. Meta-analysis showed that glutamine-supplemented enteral nutrition could decrease APACHEⅡ score (MD=-2.20, 95% CI -2.70-1.71, P<0.000 01), CRP (SMD=-1.20, 95% CI -1.37-1.02, P<0.000 1), IL-6 (SMD=-2.09, 95% CI -2.31-1.87, P<0.000 01), TNF-α (SMD=-2.61, 95% CI -2.82-2.39, P<0.000 01) when compared with conventional enteral nutrition, and could shorten the hospital stay (MD=-4.84, 95% CI -8.08-1.60, P=0.003). However, no significant differences in the incidence of complications (RR=0.84, 95% CI 0.66-1.06, P=0.15) and mortality (RR=0.88, 95% CI 0.51-1.51, P=0.64) were found between the two groups. Conclusions: Glutamine-supplemented enteral nutrition can reduce the inflammation level and improve the severity of SAP, but it has no effect on the incidence of complications and mortality.