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.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
摘要:目的: 探讨益活清下法早期联用用丙氨酰谷氨酰胺二肽治疗重症急性胰腺炎(severe acute pancreatitis, SAP)的疗效。 方法 :依据纳入和排除标准,选取我院中西医结合科收治的SAP80例,按1︰1随机分成早期组(40例)和晚期组(40例),早期组入院时便应用丙氨酰谷氨酰胺二肽治疗;晚期组入院5 d后加用丙氨酰谷氨酰胺二肽治疗。 结果 :两组入院时Ranson评分、CT评分、APACHEⅡ评分无统计学差异(P ＞005),治疗15 d后早期组APACHEⅡ评分(497±239分)明显低于晚期组(863±357分)(P ＜001);两组并发ARDS、肾功能衰竭、休克、肝功能不全、心功能衰竭、脑病及肠麻痹的发生率无统计学差异(P ＞005);早期组ARDS、肾功能衰竭、休克、肝功能不全、脑病及肠麻痹持续时间及住院病程短于晚期组(P＜005 );早期组感染率、手术中转率及病死率低于晚期组(P＜005 )。 结论 :益活清下法早期应用丙氨酰谷氨酰胺二肽治疗SAP,可缩短并发症的持续时间及病程,降低病死率和手术中转率。Abstract: Objective: To compare the effects of integrated basal treatment of Chaiqin Chengqi Decoction with alanylglutamine Dipeptide giving in different times for sever acute pancreatitis. Methods : The randomized parallel control was adopted. 80 patients of SAP were randomized to earlytreated group (40 cases were treated by AlaGln as soon as who entered hospital) and latetreated group (40 cases were treated by AlaGln after 5 days from who had entered hospital). The mortality, incidences of complication, operation and mortality,the duration of complication and the course of diseases, hospitalization were compared. Results : The mortality shown that in earlytreated group was lower than the latertreated group, there was statistically significantly difference. Ranson score, CT score, Acute Physiology and Chronic Heath EvaluationⅡscore (APACHEⅡ score) and the incidences of complications were no statistical differencein the two groups(P ＞005)in the early stage of hospitalization. But the APACHEⅡ score (497±239)in earlytreated group was lower than those in latetreated group(863±357)after 15 days(P ＜001 The duration of acute respiratory distress syndrome(ARDS ),renal failure, shock, hepatic failure, encephalopathy and enteroplegia were shorter in earlytreated group than those in latetreated group(P＜005 . The incidence of infection, operation and mortality were lower in earlytreated group than those in latetreated group(P＜005 . The course of diseases of earlytreated group was shorter than that of latetreated group (P＜005 . Conclusion : SAP treated by (CQCQD) and AlaGln in early stage can shorten the duration of complications and the hospitalization period, and reduce the incidences of infection, operation rates and mortality rate.
ObjectiveTo evaluate the impact of using alanyl-glutamine dipeptide on clinical outcome for gastric cancer patients with nutritional risk after total gastrectomy. MethodsThis study was carried out in the period from March to August 2015. The nutritional risk was screened by continuous sampling method in the new hospitalized patients with gastric cancer who would undergo total gastrectomy. The patients were grouped randomly. Alanyl-glutamine was given to the experimental group patients. The clinical data of the two groups were analyzed, such as the laboratory parame-ters of nutritional status and hepatorenal function, complications of surgery, the nutrition-related hospitalization day, etc. ResultsThe preoperative data were consistent in the two groups of the included 40 cases. The results showed, in the third and seventh days after surgery, the level of plasma albumin was higher in the experimental group than in the control group〔(33.9±5.6) g/L vs. (30.8±4.0) g/L and (36.6±3.9) g/L vs. (33.9±4.2) g/L, respectively). Also, the CD4+/CD8+ cells immune index was significantly improved in the experimental group after surgery (1.7±0.7 vs. 1.2±0.3, P < 0.05). The recovery time of intestinal function〔(65.7±5.3) h vs. (71.6±7.2)h, P < 0.01)〕and nutrition-related hospitalization day〔(10.1±1.8) d vs. (11.7±1.9)d, P < 0.01)〕in alanyl-glutamine dipeptide group were shorted than that in the control group. No serious adverse drug reactions were found in the patients during the treatment period. ConclusionApplication alanyl-glutamine to the patients with nutritional risk after total gastrectomy could partly improve clinical outcome indicators.
Warfarin is one of the most frequently prescribed oral anticoagulant. Many researches have shown that the genotypes have been strongly associated with warfarin maintenance doses. Especially, it has been accepted in academia that cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex 1 subunit (VKORC1) could affect the warfarin maintenance doses. There are also many other genotypes that were reported to be related to warfarin doses, but the results have been in controversial so far. The studies found that the dose formula which contained the genetic factors and clinical information could accurately predict the maintenance dose of warfarin, however, its usefulness is suspected due to the inconsistent results of clinical trials. Large-sample and multi-center studies are necessary to verify the specific effects of gene and non-gene factors to warfarin dose; at the same time, testing constructed models or building new models help to improve the explained percentages of individual differences.
ObjectiveTo summarize the current status of research in nutritional support for glutamine after hepatectomy.MethodThe literatures on nutritional support of glutamine after hepatectomy in recent years were reviewed by searching domestic and foreign literatures.ResultsThe administration of glutamine up-regulated the expression of liver regeneration genes after partial hepatectomy in malnourished rats, and then stimulated cell mitosis by paracrine and endocrine cells, affecting the uptake of amino acids by hepatocytes and intestinal cells, and promoting hepatocyte proliferation. In clinical applications, glutamine could improve postoperative liver function and immune function, reduce the incidence of infectious complications, then relatively shorten the length of hospital stay, and improve the clinical outcome of patients.ConclusionGlutamine is beneficial to the recovery of liver function and has clinical application value.
ObjectiveTo investigate the effects of early enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine on inflammatory response and immune function of postoperative gastric cancer patients.MethodsA total of 110 patients, accepting radical operation for gastric cancer in West China Hospital of Sichuan University during October 2017 to December 2018, were prospectively incorporated in the study and were randomly divided into 2 groups equally. Patients in the control group were enterally fed with a formula containing ω-3 polyunsaturated fatty acids for 6 consecutive days after surgery. Patients in the experimental group accepted the same enteral feeding but combined with intravenous infusion of alanyl-glutamine (20 g/d). Both enteral feeding and intravenous infusion started within 24 hours after surgery. Peripheral venous blood was gathered within 3 days before surgery and on the morning of the first, third, and seventh postoperative days to detect inflammatory, immunological, and nutritional indexes. Complications, length of hospital stay, and hospital cost were also taken notes.ResultsFifty-two patients in the control group and fifty-two patients in the experimental group respectively finished the study. In both groups, 3 patients withdrew from the study for inadequacy of radical operation. Neutrophilic granulocyte percentage, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on the third postoperative day, C-reactive protein (CRP), procalcitonin (PCT), IL-6, and TNF-α on the seventh postoperative day, were significantly lower in the experimental group (P<0.05). Immunological indexes including immunoglobulin G (IGG), immunoglobulin A (IGA), percentage of CD3+ T cells, and percentage of CD4+ T cells, nutritional markers including total protein (TP), plasma albumin (ALB), and prealbumin (PAB) were significantly higher in the experimental group on the seventh postoperative day (P<0.05). When the study ended, none significant differences of the rates of both infectious complications (wound infection, intra-abdominal infection, pulmonary infection, urinary system infection, blood system infection, and anastomotic fistula) and noninfectious complications (diarrhea, abdominal distension, and abdominal pain) were observed between the two groups (P>0.05). Time of the first anal discharge, length of hospital stay, and hospitalization cost between the two groups were not significantly different neither (P>0.05).ConclusionEarly enteral nutrition containing ω-3 polyunsaturated fatty acids combined with intravenous infusion of alanyl-glutamine contributes to reduce inflammatory response and improve immune function and nutrition status of patients with gastric cancer after surgery.