醯胺酸（Glutamine）ICU病人 無效??!!

國外研究：麩醯胺酸針劑 對癌友沒效2014/02/17 【聯合報╱記者楊欣潔、張嘉芳／台北報導】 不少癌症病患接受手術或化療、放療後，常食用營養補充品「麩醯胺酸（Glutamine）」，以增強免疫力及幫助組織修復。但國外針對重症病患的研究發現，患者使用麩醯胺酸針劑不但沒效，死亡率反而變高，研究結果刊登在「新英格蘭期刊」上。代理進口麩醯胺酸的吉泰藥品表示，營養食品都有正、負面評價，目前已有非常多篇研究肯定麩醯胺酸的效用，負面效果研究則極少。另一家業者台灣雀巢公司則表示，未看到該篇研究，也沒聽過相關說法，目前無法回應。和信醫院放射腫瘤科主任鄭鴻鈞說，新英格蘭期刊登出橫跨歐、美、加的跨國研究，針對一千兩百多名加護病房患者進行隨機雙盲試驗，在醫師及患者都不知道使用何種營養品的情況下，發現注射麩醯胺酸患者在一個月或半年的死亡率達百分之卅二，比食用安慰劑的對照組死亡率百分之廿七要高。基隆長庚醫院血液腫瘤科主任王正旭表示，此研究是針對加護病房的重症患者，與國內很多癌友使用者的情況不同；且該研究針對針劑的麩醯胺酸，也跟國內患者普遍採用的口服劑型有別。台北馬偕醫院癌症中心主任謝瑞坤說，國內常使用的麩醯胺酸為營養補充品，其功能是幫助化療中的病患減緩副作用的不適感，如嘔吐、腹瀉、口腔潰爛、末梢肢體感覺異常及修復黏膜組織破損，本身不具療效。

A Randomized Trial of Glutamine and Antioxidants in Critically Ill Patients

N Engl J Med 2013; 368:1489-1497April 18, 2013 METHODS In this blinded 2-by-2 factorial trial, we randomly assigned 1223 critically ill adults in 40 intensive care units (ICUs) in Canada, the United States, and Europe who had multiorgan failure and were receiving mechanical ventilation to receive supplements of glutamine, antioxidants, both, or placebo. Supplements were started within 24 hours after admission to the ICU and were provided both intravenously and enterally. The primary outcome was 28-day mortality. Because of the interim-analysis plan, a P value of less than 0.044 at the final analysis was considered to indicate statistical significance. RESULTS: There was a trend toward increased mortality at 28 days among patients who received glutamine as compared with those who did not receive glutamine (32.4% vs. 27.2%; adjusted odds ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.64; P=0.05). In-hospital mortality and mortality at 6 months were significantly higher among those who received glutamine than among those who did not. Glutamine had no effect on rates of organ failure or infectious complications. Antioxidants had no effect on 28-day mortality (30.8%, vs. 28.8% with no antioxidants; adjusted odds ratio, 1.09; 95% CI, 0.86 to 1.40; P=0.48) or any other secondary end point. There were no differences among the groups with respect to serious adverse events (P=0.83).