Objective To evaluate the effects of enhanced enteral nutrition combined with glutamine (Gln) on therapeutic outcomes in patients with severe acute pancreatitis (SAP) through a meta-analysis. Methods Relevant studies on enteral nutrition combined with Gln in SAP patients were retrieved from databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, National Science and Technology Digital Library, PubMed, Cochrane Library, Embase, and Google Scholar, with a search timeframe spanning from the inception of each database to October 8, 2021. Two independent reviewers screened the literature based on predefined inclusion and exclusion criteria, focusing on randomized controlled trials (RCTs) in which the experimental group received enhanced enteral nutrition combined with Gln, and the control group received standard enteral nutrition alone. The quality of included studies was assessed using the Cochrane Handbook for Systematic Reviews, and statistical analysis was performed using RevMan 5.4 software. Results Nine studies involving 601 patients (298 in the experimental group and 303 in the control group) were included. Meta-analysis results demonstrated that, compared to the control group, the experimental group exhibited significantly lower post-treatment levels of hypersensitive C-reactive protein (hs-CRP) (MD=-1.37, 95%CI: -1.89, -0.86; P<0.05) and interleukin-6 (IL-6) (MD=-5.00, 95%CI: -6.85, -3.14; P<0.05), as well as significantly higher levels of serum albumin (MD=3.46, 95%CI: 2.26, 4.65; P<0.05) and serum prealbumin (MD=42.15, 95%CI: 21.46, 62.84; P<0.05). Additionally, the total hospital stay was significantly shorter in the experimental group (MD=-8.86, 95%CI: -17.06, -0.66; P<0.05). Conclusion Enhanced enteral nutrition combined with Gln significantly improves inflammatory and nutritional indicators in SAP patients and reduces the total hospital stay. Therefore, enhanced enteral nutrition combined with Gln is recommended for SAP patients to consolidate therapeutic efficacy.
WANG Liting
,
QIAO Na
,
CHANG Shulin
,
LU Yan
,
LIU Jingli
. Meta-analysis on efficacy of enhanced enteral nutrition combined with glutamine in patients with severe acute pancreatitis[J]. Surgical Research and New Technique, 2025
, 14(1)
: 23
-30
.
DOI: 10.3969/j.issn.2095-378X.2025.01.005
[1] Guo DX, Dai W, Shen JY, et al.Assessment of prophylactic carbapenem antibiotics administration for severe acute pancreatitis: an updated systematic review and meta-analysis[J]. Digestion, 2022, 103(3): 183-191.
[2] Phillip V, Steiner JM, Algül H.Early phase of acute pancreatitis: assessment and management[J]. World J Gastrointest Pathophysiol, 2014, 5(3): 158-168.
[3] Mifkovic A, Pindak D, Daniel I, et al.Septic complications of acute pancreatitis[J]. Bratisl Lek Listy, 2006, 107(8):296-313.
[4] 李天洋,古维立.降低急性胰腺炎的病死率:基于日本2021版诊疗指南的探讨[J].广州医药,2024,55(1):9-17.
[5] 王卿. 重症急性胰腺炎患者采用早期肠内营养治疗的作用——评《重症急性胰腺炎临床新技术》[J].中国实验方剂学杂志,2022,28(4):90.
[6] Fürst P, Pogan K, Stehle P.Glutamine dipeptides in clinical nutrition[J]. Nutrition, 1997, 13(7-8): 731-737.
[7] Al Samaraee A, McCallumI JD, Coyne E, et al. Nutritional strategies in severe acute pancreatitis: a systematic review of the evidence[J]. Surgeon, 2010, 8(2): 105-110.
[8] Shan LN, Bai SX, Zhao M.Early diagnosis of serum sICAM-1 and sRAGE in severe acute pancreatitis, and efficacy and prognosis prediction of glutamine combined with ulinastatin[J]. Exp Ther Med, 2021, 21(4): 324.
[9] Arutla M, Raghunath M, Deepika G, et al.Efficacy of enteral glutamine supplementation in patients with severe and predicted severe acute pancreatitis—A randomized controlled trial[J].Indian J Gastroenterol, 2019, 38: 338-347.
[10] 吴丹,李勇. 肠内早期给予谷氨酰胺对重症急性胰腺炎患者临床预后的影响[J]. 九江学院学报(自然科学版),2010,25(1):110-111.
[11] 赵忠英,李亚兰,张旭. 谷氨酰胺肠内营养在急性胰腺炎治疗中的疗效分析[J]. 实用医院临床杂志,2017,14(6):195-197.
[12] 王玮,张露. 谷氨酰胺联合早期肠内营养治疗急性重症胰腺炎疗效观察及对炎症因子的影响[J]. 现代消化及介入诊疗,2016,21(5):682-685.
[13] 金晶,周一农,姜明. 谷氨酰胺联合早期肠内营养治疗重症急性胰腺炎的效果[J]. 中国现代医生,2019,57(22):4-8.
[14] 杨成,文静,夏敏,等. 谷氨酰胺营养支持对急性重症胰腺炎患者肠黏膜屏障功能及炎症反应程度的影响[J]. 海南医学院学报,2017,23(14):1896-1899.
[15] 孙一博. 谷氨酰胺与早期肠内营养对重症急性胰腺炎患者的影响[J]. 实用中西医结合临床,2019,19(9):17-19.
[16] 袁小祥,昝建宝,徐爱忠,等. 联合Gln的早期肠内营养对SAP患者全身炎症反应和免疫功能的影响[J]. 肝胆胰外科杂志,2018,30(1):22-25.
[17] 赵翠娟,陈强,陈吉,等. 早期肠内营养联合谷氨酰胺在重症急性胰腺炎中的应用[J]. 中国继续医学教育,2017,9(5):135-137.
[18] Thapa R, Iqbal Z, Garikipati A, et al.Early prediction of severe acute pancreatitis using machine learning[J]. Pancreatology, 2022, 22(1): 43-50.
[19] 刘敏,张长城,顿耀艳. 谷氨酰胺对肠道黏膜屏障功能保护作用的研究进展[J]. 广东医学,2016,37(22):3463-3465.
[20] Wasa M, Soh H, Shimizu Y, et al.Glutamine stimulates amino acid transport during ischemia-reperfusion in human intestinal epithelial cells[J].J Surg Res, 2005, 123(1): 75-81.
[21] 刘敏,张长城,顿耀艳. 谷氨酰胺对肠道黏膜屏障功能保护作用的研究进展[J]. 广东医学,2016,37(22):3463-3465.
[22] 常学锋,曲萌,初贵富,等. 免疫肠内营养结合中医中药治疗急性放射性肠炎的疗效[J]. 中国老年学杂志,2024,44(6):1329-1332.