Advanced enteral therapy in acute pancreatitis: is there a room for immunonutrition? A meta-analysis.
Advanced enteral therapy in acute pancreatitis: is there a room for immunonutrition? A meta-analysis.
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DOI：
10.1016/j.ijsu.2008.01.003
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发表时间：
2008-04-01
期刊：
影响因子：
--
通讯作者：
Zagainov, Vladimir E
中科院分区：
文献类型：
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作者：
Petrov, Maxim S;Atduev, Vagif A;Zagainov, Vladimir E
背景：人们认为某些营养物质如谷氨酰胺、精氨酸和omega-3脂肪酸可能在急性胰腺炎的代谢、炎症和免疫过程中发挥重要作用。本系统综述旨在确定在急性胰腺炎患者肠内营养中添加这些物质是否比标准肠内配方有任何临床益处。方法：计算机检索电子数据库（Cochrane Central Register of Controlled Trials， EMBASE和MEDLINE）和人工检索主要胃肠病学会议（UEGW， DDW）的摘要。研究结果为总感染并发症、住院死亡率和住院时间。使用随机效应模型对数据进行meta分析。结果：共有3项随机对照试验符合纳入标准。与标准肠内营养相比，免疫营养与总感染并发症（风险比0.82；95%可信区间0.44-1.53；P=0.53）和死亡（风险比0.64；95%可信区间0.20-2.07；P=0.46）的显著降低无关。两组患者住院时间平均差异无统计学意义（P=0.80）。结论：没有证据表明，与标准肠内营养相比，补充谷氨酰胺、精氨酸和/或omega-3脂肪酸的肠内营养对急性胰腺炎的感染并发症、死亡率或住院时间有任何有益影响。可以提倡在这类患者中寻求肠内制剂的新组合物。
BACKGROUND: It is believed that certain nutrients such as glutamine, arginine and omega-3 fatty acids may play a significant role in metabolic, inflammatory, and immune processes in acute pancreatitis. The present systematic review aimed to define whether the addition of these substances to enteral nutrition provides any clinical benefit over standard enteral formulas in patients with acute pancreatitis.METHODS: A computerized search on electronic databases (Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE) and manual search of the abstracts of major gastroenterological meetings (UEGW, DDW) were undertaken. The studied outcomes were total infectious complication, in-hospital mortality and length of hospital stay. The data were meta-analyzed using a random-effects model.RESULTS: A total of three randomized controlled trials satisfied the inclusion criteria. When compared with standard enteral nutrition, immunonutrition was not associated with the significantly reduced risk of total infectious complications (risk ratio 0.82; 95% confidence interval 0.44-1.53; P=0.53) and death (risk ratio 0.64; 95% confidence interval 0.20-2.07; P=0.46). Mean difference in length of hospital stay between two groups was not significant (P=0.80).CONCLUSIONS: There is no evidence that enteral nutrition supplemented with glutamine, arginine and/or omega-3 fatty acids, in comparison with standard enteral nutrition, has any beneficial effect on infectious complications, mortality or length of hospital stay in acute pancreatitis. The pursuit of new compositions of enteral formulations in this category of patients may be advocated.