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中国癌症防治杂志

中国癌症防治杂志 ›› 2019, Vol. 11 ›› Issue (1): 68-75.doi: 10.3969/j.issn.1674-5671.2019.01.12

• 临床研究 • 上一篇    下一篇

免疫增强型肠内营养对中国人群胃癌根治术后免疫功能影响的Meta分析

  

  1. 湖北省黄冈市红安县人民医院
  • 出版日期:2019-02-25 发布日期:2019-03-28

Meta-analysis of immune-enhanced enteral nutrition on immune function after radical gastrectomy in Chinese

  • Online:2019-02-25 Published:2019-03-28

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摘要： 目的 系统评价胃癌根治术后患者应用免疫增强型肠内营养制剂辅助治疗对免疫功能的影响。方法 计算机检索中国知网、万方医学网、维普医学网、中国生物医学网、PubMed、EMBASE等数据库，搜集胃癌根治术后患者采用免疫增强型肠内营养制剂辅助治疗对免疫功能影响的相关临床随机对照研究，目标人群为中国人群，检索期限均为建库至2018年7月。按照文献纳入及排除标准，筛选文献、提取资料并评价纳入文献的偏倚风险，采用 RevMan 5.3 软件进行 Meta 分析。结果 共纳入10篇文献，合计534例患者，其中采用免疫增强型肠内营养制剂（试验组）283例，常规肠内营养制剂（对照组）251例，文献质量评价均为B级。细胞免疫指标Meta分析结果显示，试验组术后1 d CD3水平低于对照组 （MD=-2.06，95%CI：-3.68~-0.43，P=0.01），其余指标差异无统计学意义。术后7~10 d试验组CD3、CD4、CD4/CD8、NK水平高于对照组（MDCD3=6.74，95%CI：1.36~12.12，P<0.01；MDCD4=5.93，95%CI：3.68~8.19，P<0.001；MDCD4/CD8=0.53，95%CI：0.33~0.73，P<0.001；MDNK=1.40，95%CI：0.05~2.76，P<0.05），两组CD8水平差异无统计学意义（MD=2.00，95%CI：-2.87~6.88，P=0.42）。体液免疫指标Meta分析结果显示，术后1 d试验组和对照组IgA、IgM、IgG水平差异均无统计学意义，术后7~10 d试验组IgA、IgM、IgG水平均高于对照组（MDIgA=0.33，95%CI：0.24~0.41，P<0.001；MDIgM=0.21，95%CI：0.14~0.27，P<0.001；MDIgG=1.91，95%CI：1.11~2.72，P<0.001］。 结论 胃癌根治术后患者采用免疫增强型肠内营养制剂7~10 d后在改善患者免疫功能中较常规肠内营养制剂有优势，但术后1 d效果不明显。

关键词: 胃肿瘤, 中国人群, 肠内营养, 免疫功能, Meta分析

Abstract: Objective To evaluate the immune function of patients with gastric cancer who were given immune-enhanced enteral nutrition preparation after radical gastrectomy. Methods CNKI，WanFang，VIP，CBM，PubMed and EMBASE databases were searched to collect randomized controlled trials （RCTs） on immunological function of patients after radical gastrectomy with immune-enhanced enteral nutrition from inception to July，2018. Retrieve objects were Chinese population. According to the literature inclusion criteria and exclusion criteria，screened the literature，extracted the data and evaluated the risk of bias in the literature．Meta-analysis was conducted by RevMan 5.3 software. Results A total of 10  RCTs were included in the study，involving 534 patients，of whom，283 cases underwent immune-enhanced enteral nutrition（experimental group） and 251 cases underwent conventional enteral nutrition （control group）. The quality of the literatures was B grade. Meta-analysis of cellular immune indicators showed that the level of CD3 in the experimental group on the first day after surgery was lower than that in the control group（MD=-2.06，95%CI：-3.68--0.43，P=0.01），while the other indicators were not statisti-cally significant. The levels of CD3，CD4，CD4/CD8 and NK in the experimental group were higher than those in the control group on 7-10 days after surgery （MDCD3=6.74，95%CI：1.36-12.12，P<0.01；MDCD4=5.93，95%CI：3.68-8.19，P<0.001；MDCD4/CD8=0.53，95%CI：0.33-0.73，P<0.001；MDNK=1.40，95%CI：0.05-2.76，P<0.05），but the level of CD8 was no significant difference between the two groups（MD=2.00，95%CI：-2.87-6.88，P=0.42）. Meta-analysis of humoral immune indicators showed that there was no significant difference in IgA，IgM and IgG level between the experimental group and the control group on the first day after operation. However，the IgA，IgM and IgG level in the experimental group were higher than those in the control group on 7-10 days after surgery（MDIgA=0.33，95%CI：0.24-0.41，P<0.001；MDIgM=0.21，95%CI：0.14-0.27，P<0.001；MDIgG=1.91，95%CI：1.11-2.72，P<0.001）. Conclusions After radical surgery for gastric cancer，the immune-enhanced enteral nutrition preparations have advantages over conventional enteral nutrition preparations in improving immune function of patients after 7-10 days，but the effect on the first day after surgery is not obvious.

Key words: Gastric neoplasms, Chinese population, Enteral nutrition, Immune function, Meta-analysis

中图分类号: 

  • R735.2