Alanyl-glutamine Dipeptide for Severe Acute Pancreatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yanping ¹ , JIAO Kai ¹ , LI Debang ² , DONG Chunlu ² , WU Xinan ¹ ,  LIU Xiaoju ³

1. Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China;2. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;3. Department of Respiratory, The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LIU Xiaoju, Email: liu_xiaoju@yahoo.com.cn

Keywords：

Alanyl-glutamine dipeptide; Severe acute pancreatitis (SAP); Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20130192

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis (SAP).
Methods 　Such databases as MEDLINE, EMbase, CENTRAL, VIP, WanFang Data, CBM and CNKI were electronically searched from inception to October, 2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2.
Results 　Five trials were included involving a total of 227 patients. The results of meta-analysis showed that: compared with the control group, the alanyl-glutamine dipeptide group had the lower incidence of SAP complications (RR=0.41, 95%CI 0.20 to 0.82), the lower incidence of infected pancreatic necrosis (RR=0.12, 95%CI 0.02 to 0.89), less time for alleviating bellyache (MD= –0.90, 95%CI –1.72 to –0.08). There was a tendency in decreasing SAP mortality (RR=0.15, 95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase (SMD=0.37, 95%CI –0.04 to 0.79).
Conclusion 　Current evidence shows that, alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis, and shorten the time for alleviating bellyache in SAP patients. Due to the limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.

Citation： WANG Yanping,JIAO Kai,LI Debang,DONG Chunlu,WU Xinan,LIU Xiaoju. Alanyl-glutamine Dipeptide for Severe Acute Pancreatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(9): 1123-1128. doi: 10.7507/1672-2531.20130192 Copy

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.

Previous Article
Effectiveness and Safety of Zhibitai versus Atorvastatin for Hyperlipidemia: A Systematic Review
Next Article
Effects of Lidocaine on Preventing Pain on Injection of Propofol: A Meta-Analysis

Chinese Journal of Evidence-Based Medicine

Alanyl-glutamine Dipeptide for Severe Acute Pancreatitis: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content