谷氨酰胺强化肠内营养支持对梗阻性黄疸大鼠肠屏障保护效应的Meta分析  

Effect of glutamine enriched nutrition support on gut barrier of rats with obstructive jaundice: A Metaanalysis

作　　者：曹学峰[1,2] 王西秀[1,2] 林绪涛[1,2] 管清海[1,2] 张兴元[1,2] 陈强谱[1,2] 

机构地区：[1]山东省滨州医学院附属医院肝胆外科 [2]山东省滨州医学院附属医院临床营养支持中心,山东省滨州市256603

出　　处：《世界华人消化杂志》2015年第9期1500-1509,共10页World Chinese Journal of Digestology

基　　金：山东省滨州医学院校级科技计划基金资助项目;No.BY2011KJ006~~

摘　　要：目的:系统评价谷氨酰胺强化营养支持对梗阻性黄疸大鼠肠屏障的保护效应。方法:以"glutamine"、"obstructive jaundice(OJ)"为检索词检索PubMed、Embase、HighWire、Cochrane Central Register of Controlled Trials.检索时间为各数据库建库至2014-11.最终纳入梗阻性黄疸后常规喂养对比谷氨酰胺强化营养支持对大鼠肠屏障保护效应的随机对照实验,再由2名高年资研究者独立筛查文献和提取数据,并进行文献质量评价,用RevMan4.2软件进行Meta分析.计数资料采用相对危险度(relative risk,RR)及95%可信区间(95%confidence interval,95%CI)进行分析,计量资料采用标准均数差(standard mean difference,SMD)或加权均数差(weighted mean difference,WMD)及95%CI进行分析.采用I^2对异质性进行定量分析.结果:共纳入符合标准的文献8篇,均为随机对照实验研究.累计样本量152例,其中行梗阻性黄疸后常规喂养大鼠76例(对照组),行谷氨酰胺强化营养支持大鼠76例(实验组).Meta分析结果显示:与对照组比较,实验组梗阻性黄疸大鼠肠系膜淋巴结、肝脏、脾脏、血液细菌易位率下降(RR分别为0.34、0.36、0.38、0.30、P值均<0.05)、肠黏膜抗氧化能力增强(WMD_(MPO)及WMD_(MDA)分别为-0.44、-57.87,对应95%CI分别为-0.85--0.03、-104.14--11.60,P值均<0.05),但肝功能损害及肠绒毛病理损伤无明显改善.结论:谷氨酰胺强化肠内营养支持对梗阻性黄疸大鼠肠屏障功能具有保护效应,该保护作用体现为有效降低黄疸发生时的细菌易位率、显著增强黄疸发生时肠黏膜抗氧化能力.AIM：To systematically assess the effect of glutamine enriched enteral nutrition support on the gut barrier of rats with obstructive jaundice（OJ）.METHODS：Databases including PubMed,Embase,High Wire and Cochrane Central Register of Controlled Trials were searched using keywords ＂glutamine＂, ＂obstructive jaundice＂.Literature published before November 2014 was searched.Randomized controlled trials comparing conventional treatment and glutamine enriched nutrition support were enrolled in the study,and then the literature was screened and the data were extracted by two independent reviewers.The quality of the literature was assessed,and the data were analyzed using the RevMan4.2software.Count data were analyzed using relative risk（RR） and 95%confidence interval（95%CI）,and measurement data were analyzed using standard mean difference（SMD） or weighted mean difference（WMD） and 95%CI.The heterogeneity of the data was analyzed using the I2 test.RESULTS：Eight articles including 152 cases were enrolled in the study,and all of them were prospective randomized controlled studies.There were 76 rats treated by conventional methods（control group） and76 rats receiving glutamine enriched nutrition support（experimental group）.Compared with the control group,glutamine enriched nutrition support could decrease the rates of bacterial translocation（BT） to mesenteric lymph nodes（MLNs）,the liver,spleen and blood（RR = 0.34,0.36,0.38,0.30,P〈0.05）,and enhance the antioxidant capacity of the intestinal mucosa（WMD_（MPO）=-0.44,WMD_（MDA） =-57.87;95%CI：-0.85-0.03,-104.14-11.60;P〈0.05）,but could not significantly improve the liver dysfunction and intestinal villi.CONCLUSION：Glutamine enriched nutrition support has a protective effect on intestinal barrier function in rats with OJ in terms of reducing BT effectively and enhancing the antioxidant capacity of the intestinal mucosa significantly.

关 键 词：梗阻性黄疸 谷氨酰胺 META分析 

分 类 号：R575[医药卫生—消化系统]