| BACKGROUNDGlutamine (Gin) dipeptide, as a nutrtional agent, is widely applied in clinical setting. An increasing number of studies have confirmed that glutamine dipeptide can improve the clinical outcome of patients receiving abdominal surgery, such as reducing infectious morbidity and mortality as well as shortening the length of hospital stay, but others held the opposite view. Hence, the significance of its clinical application remains controversial.OBJECTIVETo systematically evaluate the clinical significance and economic value of glutamine dipeptide supplementation for abdominal surgical patients.METHODThe Cochrane Library, Pubmed, EMbase, CBM, CNKI, VIP and Wanfang Data from year1989to year2012were searched electronically and randomized controlled trials (RCTs) about glutamine dipeptide-enhanced total parenteral nutrition (TPN) for patients undertaking abdominal surgery were included. Patients in the trial group were treated with TPN supplemented with Gin dipeptide, and those in control group treated with isonitrogenous and isocaloric TPN. The quality of included studies was assessed by two independent researchers according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions and meta-analyses were performed for homogeneous studies using Cochrane Collaboration’s RevMan5.1.The potential publication bias was assessed by Contour-enhanced funnel plot and Harbord’s test through Stata/SE12software. Trim and fill method was adopted to conduct sensitive analysis.RESULTSThirty-three RCTs involving1490patients were included in meta-analysis.Seven studies were graded low risk of bias, sixteen studies graded moderate risk of bias and ten studies graded high risk of bias. Meta-analyses showed that as compared to the TPN, glutamine dipeptide-enhanced TPN can reduce the postoperative infectious morbidity [RR=0.42,95%CI (0.30,0.59)(P<0.00001)], shorten mean hospital stay time [WMD=-3.25d,95%CI (-4.22,-2.671)(P<0.00001)], increase cumulative nitrogen balance [WMD=9.86g,95%CI (6.05,13.67)(P<0.00001)], accelerate the recovery of gastrointestinal function [WMD=-11.22h,95%CI (-20.21,-2.24)(P=0.01)], decrease mucosal permeability [WMD=-0.03,95%CI (-0.02,-0.04)](P<0.00001), but both the postoperative mortality [RR=0.94,95%CI (0.19,4.60)(P=0.94)] and total cost of hospital stay[WMD=-538.13,95%CI (-2795.58,1719.32)(P=0.64)] was similar between intervention arm and control one. Subgroup analysis of the two parameters, infectious morbidity and mean hospital stay time, was conducted according to high (≥0.5g·kg-1·d-1) or low (<0.5g·kg-1·d-1) dose of glutamine dipeptide, which showed that there was no statistical difference between the high dose and low dose of glutamine dipeptide in reducing infectious morbidity or shortening mean hospital stay time. The result of Harbord’s test indicted that publication bias was not existent within this meta-analysis. Furthermore, the trim and fill method was adopted to show that the result of this meta-analysis was stable.CONCLUSION 1. The glutamine dipeptide can strengthen gut mucosal barrier function of patients receiving the abdominal surgical operation, reduce the permeability of intestinal mucosa, promote the recovery of gastrointestinal function and improve the cumulative nitrogen balance.2. The glutamine dipeptide can improve clinical outcome in patients undertaking abdominal surgical operation, such as reducing the postoperative infectious morbidity and shortening mean hospital stay time.3. The available evidence failed to unveil that the high dose (≥0.5g·kg-1·d-1) of glutamine dipeptide was superior to low dose (<0.5g·kg-1·d-1) in improving clinical outcome in patients receiving abdominal surgical operation.4. The existing evidence can not make sure its effect on postoperative mortality and hospitalization expenses, which need to be confirmed by more randomized controlled clinical trials of high quality and larger sample size. |
PDF Full Text Request