摘要
目的研究精氨酸强化的免疫营养支持对胃癌患者术后免疫功能以及感染并发症发生率的影响。方法检索Pub Med、Cochrane图书馆、EMBASE、Web of Science、中国知网、万方、维普等数据库,采集所有研究精氨酸强化的免疫营养应用于胃癌患者术后营养支持的临床随机对照试验,发表年限为1996年至2017年1月。并通过互联网检索相关学位论文、会议摘要等灰色文献。采纳Cochrane协作网提供的偏倚风险评估量表联合修改后的Jadad量表进行文献质量评价,由两位评价者独立评价纳入的文献,并使用Rev Man 5.2软件进行Meta分析。结果共检索到241篇文献,最终纳入13篇,样本量为947例。Meta分析结果:围手术期应用精氨酸强化的免疫营养可降低胃癌患者术后感染率(比值比0.42,95%可信区间0.21~0.86,P=0.02,差异有统计学意义)。同时可增强细胞免疫功能,CD3+T细胞亚群均数差4.95,95%可信区间3.82~6.08,P<0.000 01;CD4+T细胞亚群均数差5.38,95%可信区间3.02~7.74,P<0.000 01;CD8+T细胞亚群均数差-1.46,95%可信区间-2.53^-0.39,P=0.008;CD4+/CD8+比值均数差0.26,95%可信区间0.02~0.50,P=0.03;且试验组反映体液免疫功能的各指标(Ig A、Ig G、Ig M等)较对照组明显升高,组间差异均有统计学意义。结论精氨酸强化的免疫营养可增强胃癌患者术后免疫功能,减少术后感染性并发症的发生。
Objective To explore the effects of arginine-enhanced immunonutritional support on postoperative immune function and incidence of infected complications in patients with gastric cancer.Methods Pub Med,Cochrane Library,EMBASE,Web of Science,CNKI,Wanfang database,VIP database and other databases were retrieved to collect all the randomized controlled trials(RCTs)published from 1996 to January 2017,of which researched arginineenhanced immunonutrition applied in patients with gastric cancer who need postoperative nutritional support.And relevant theses,meeting abstracts and other gray literature publications were searched through the internet.We conducted the quality assessment of included literatures with Cochrane Librarys risk of bias table and the modified Jadad Scale by two independent reviewers.The Rev Man 5.2 software was used for meta-analysis on homogeneous studies.Results A total of 241 literatures were retrieved,however,only 13 articles were included in this study,involving 947 cases.Meta analysis results illustrated that perioperative using of arginine-enhanced immune nutrition could reduce the rate of postoperative infection in patients with gastric cancer[OR(odds ratio)=0.42,95%CI(confidence interval)0.21~0.86,P=0.02],and the difference was statistically significant.Cellular immune function was enhanced simultaneously.CD3+T cell subsets[MD(mean difference)4.95,95%CI 3.82~6.08,P<0.000 01],CD4+T cell subsets(MD 5.38,95%CI 3.02~7.74,P<0.000 01),CD8+T cell subsets(MD-1.46,95%CI-2.53^-0.39,P=0.008)、CD4+/CD8+(MD 0.26,95% CI 0.02~0.50,P=0.03),and the indicators reflect humoral immune function(Ig A,Ig G,Ig M,etc.) in the experimental group were significantly higher than those in the control group,all the differences between the two groups were statistically significant.Conclusion Arginine-enhanced immunonutrition can enhance postoperative immune function in patients with gastric cancer and reduce the incidence of postoperative infectious complications.
出处
《循证医学》
CSCD
2017年第6期350-360,共11页
The Journal of Evidence-Based Medicine
基金
重庆市卫生计生委医学科研资助项目(2017MSXM033)
关键词
胃癌
免疫营养
精氨酸
META分析
gastric cancer
immunonutrition
arginine
meta-analysis
