Intravenous Glutamine for Severe Acute Pancreatitis:A Meta-analysis_West China Medical Journal

Authors：

 ZHONGXin , LIANGCui-ping ,  GONGShu

Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

GONGShu, Email: joybell370@gmail.com

Keywords：

Glutamine; Severe acute pancreatitis; Treatment; Randomized controlled trials; Meta-analysis

DOI：

10.7507/1002-0179.20140145

Video：

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Objective To evaluate the efficacy of intravenous glutamine on patients with severe acute pancreatitis. Methods The Cochrane Library, PubMed, EMbase, CNKI and CBM databases were searched up to January 2013. Randomized controlled trials (RCTs) that compared non-glutamine nutrition with intravenous glutamine supplemented nutrition in patients with severe acute pancreatitis were included. A method recommended by the Cochrane Collaboration was used to perform a meta-analysis of those RCTs. Results Four RCTs involving a total of 190 participants were included. Analysis of these RCTs revealed the presence of statistical homogeneity among them. Results showed that glutamine dipeptide had a positive effect on reducing the mortality rate[OR=0.26, 95%CI (0.09, 0.73), P=0.01], length of hospital stay[WMD=-4.85 d, 95%CI (-6.67, -3.03) d, P<0.001], and the rate of complications[OR=0.41, 95%CI (0.22, 0.78), P=0.006]. No serious adverse effects were found. Conclusion Current best evidence demonstrates that glutamine is effective for severe acute pancreatitis. Further high quality trials are required and parameters of nutritional condition and hospital cost should be considered in future RCTs with sufficient size and rigorous design.

Citation： ZHONGXin, LIANGCui-ping, GONGShu. Intravenous Glutamine for Severe Acute Pancreatitis:A Meta-analysis. West China Medical Journal, 2014, 29(3): 483-487. doi: 10.7507/1002-0179.20140145 Copy

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8.	Déchelotte 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[J]. Crit Care Med, 2006, 34(3):598-604.
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10.	Ockenga J, Borchert K, Rifai K, et al. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis[J]. Clin Nutr, 2002, 21(5):409-416.
11.	Sahin H, Mercanligil SM, Inanç N, et al. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis[J]. Eur J Clin Nutr, 2007, 61(12):1429-1434.
12.	韩梅, 刘彤, 刘刚, 等. 免疫营养剂对重症胰腺炎患者疗效观察[J]. 天津医科大学学报, 2011, 17(2):227-229.
13.	He XL, Qj M, Lu JG, et al. Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supplementation on outcome in severe acute pancreatitis (SAP)[J]. Clin Nutr Suppl, 2004, 1(1):43-47.
14.	Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis[J]. JPEN J Parenter Enteral Nutr, 2008, 32(4):403-411.
15.	Hajdú N, Belágyi T, Issekutz A, et al. Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis-a prospective randomized clinical study[J]. Magy Seb, 2012, 65(2):44-51.
16.	Alderson P, Green S, Higgins J. Cochrane Reviewers'Handbook 4.2.3[Updated November 2004] [M/OL]. The Cochrane collaboration,[2011-10-18]. www.stirrhs.ca/files/handbook.pdf.
17.	Beger HG, Rau B, Mayer J, et al. Natural course of acute pancreatitis[J]. World J Surg, 1997, 21(2):130-135.
18.	Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis[J]. Gastroenterology, 1997, 113(3):899-903.
19.	Norman J. The role of cytokines in the pathogenesis of acute pancreatitis[J]. Am J Surg, 1998, 175(1):76-83.
20.	Schmid SW, Uhl W, Friess H, et al. The role of infection in acute pancreatitis[J]. Gut, 1999, 45(2):311.
21.	Lankisch PG, Weber-Dany B, Doobe C, et al. Plasma glutamine levels are negatively correlated with the severity of acute pancreatitis[J]. Pancreas, 2008, 36(3):322-324.

1. Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98:database study of incidence and mortality[J]. BMJ, 2004, 328(7454):1466-1469.
2. Defrances CJ, Lucas CA, Buie VC, et al. National hospital discharge survey[J]. Natl Health Stat Report, 2008, 5(6):1-20.
3. Cavallini G, Frulloni L, Bassi C, et al. Prospective multicentre survey on acute pancreatitis in Italy (ProInf-AISP):results on 1005 patients[J]. Dig Liver Dis, 2004, 36(3):205-211.
4. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States:2012 update[J]. Gastroenterology, 2012, 143(5):1179-1187.
5. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis[J]. Cochrane Database Syst Rev, 2010(5):CD002941.
6. Wang Q, Guo Z, Zhao P. Chinese herbal medicines for acute pancreatitis[J]. Cochrane Database Syst Rev, 2005(1):CD003631.
7. Al-Omran M, Albalawi ZH, Tashkandi MF, et al. Enteral versus parenteral nutrition for acute pancreatitis[J]. Cochrane Database Syst Rev, 2010(1):CD002837.
8. Déchelotte 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[J]. Crit Care Med, 2006, 34(3):598-604.
9. Zou XP, Chen M, Wei W, et al. Effects of enteral immunonutrition on the maintenance of gut barrier function and immune function in pigs with severe acute pancreatitis[J]. JPEN J Parenter Enteral Nutr, 2010, 34(5):554-566.
10. Ockenga J, Borchert K, Rifai K, et al. Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis[J]. Clin Nutr, 2002, 21(5):409-416.
11. Sahin H, Mercanligil SM, Inanç N, et al. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis[J]. Eur J Clin Nutr, 2007, 61(12):1429-1434.
12. 韩梅, 刘彤, 刘刚, 等. 免疫营养剂对重症胰腺炎患者疗效观察[J]. 天津医科大学学报, 2011, 17(2):227-229.
13. He XL, Qj M, Lu JG, et al. Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supplementation on outcome in severe acute pancreatitis (SAP)[J]. Clin Nutr Suppl, 2004, 1(1):43-47.
14. Fuentes-Orozco C, Cervantes-Guevara G, Muciño-Hernández I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis[J]. JPEN J Parenter Enteral Nutr, 2008, 32(4):403-411.
15. Hajdú N, Belágyi T, Issekutz A, et al. Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis-a prospective randomized clinical study[J]. Magy Seb, 2012, 65(2):44-51.
16. Alderson P, Green S, Higgins J. Cochrane Reviewers'Handbook 4.2.3[Updated November 2004] [M/OL]. The Cochrane collaboration,[2011-10-18]. www.stirrhs.ca/files/handbook.pdf.
17. Beger HG, Rau B, Mayer J, et al. Natural course of acute pancreatitis[J]. World J Surg, 1997, 21(2):130-135.
18. Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis[J]. Gastroenterology, 1997, 113(3):899-903.
19. Norman J. The role of cytokines in the pathogenesis of acute pancreatitis[J]. Am J Surg, 1998, 175(1):76-83.
20. Schmid SW, Uhl W, Friess H, et al. The role of infection in acute pancreatitis[J]. Gut, 1999, 45(2):311.
21. Lankisch PG, Weber-Dany B, Doobe C, et al. Plasma glutamine levels are negatively correlated with the severity of acute pancreatitis[J]. Pancreas, 2008, 36(3):322-324.

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