精氨酸强化的肠内营养对创伤患者预后及免疫功能影响的Meta分析  

Effects of Arginine-supplemented Enteral Nutrition on the Prognosis and Immune Function of Trauma Patients:a Meta-analysis

作　　者：陈肖 阮一 何瑶 张颖 CHEN Xiao;RUAN Yi;HE Yao;ZHANG Ying(Dept.of Pharmacy,Chongqing Municipal Fourth People’s Hospital,Chongqing 400014,China)

机构地区：[1]重庆市第四人民医院药剂科,重庆400014

出　　处：《中国药房》2019年第10期1418-1423,共6页China Pharmacy

基　　金：重庆市卫生计生委医学科研计划项目(No.2016MSXM078)

摘　　要：目的:系统性评价精氨酸强化的肠内营养对创伤患者预后及免疫功能的影响。方法:计算机检索PubMed、Cochrane图书馆、Embase、中国知识基础设施工程、万方数据库、中国生物医学文献数据库、中国临床试验注册中心,收集精氨酸强化的肠内营养(试验组)对比标准肠内营养或不含精氨酸的其他肠内营养(对照组)用于创伤患者的随机对照试验(RCT),筛选文献、提取资料并按Cochrane系统评价员手册5.1.0提供的偏倚风险评估工具评价文献质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入13项RCT,共计777例患者。Meta分析结果显示,试验组患者病死率[RR=1.67,95%CI(1.07,2.61),P=0.03]、免疫球蛋白G[MD=2.81,95%CI(0.43,5.18),P=0.02]、免疫球蛋白M[MD=0.30,95%CI(0.07,0.54),P=0.01]、CD4^+[MD=5.05,95%CI(2.55,7.56),P<0.000 1]、CD4^+/CD8^+[MD=0.27,95%CI(0.11,0.44),P=0.001]均显著高于对照组,血清白蛋白[MD=-0.47,95%CI(-0.75,-0.19),P=0.000 9]显著低于对照组;两组患者感染性并发症发生率[RR=0.77,95%CI(0.51,1.17),P=0.22]、总住院时间[MD=-2.35,95%CI(-10.72,6.02),P=0.58]、免疫球蛋白A[MD=0.38,95%CI(-0.06,0.82),P=0.09]、CD8^+[MD=-2.49,95%CI(-6.01,1.03),P=0.17]、不良反应发生率比较,差异均无统计学意义。结论:精氨酸强化的肠内营养可提高创伤患者的免疫功能,但会增加患者的死亡率,临床应用时需慎重。OBJECTIVE:To systematically review the effects of arginine-supplemented enteral nutrition on the prognosis and immune function of trauma patients.METHODS:Retrieved from PubMed,the Cochrane library,Embase,CNKI,Wanfang database,CBM and Chinese Clinical Trial Registry,randomized controlled trials(RCT)about arginine-supplemented enteral nutrition(trial group)versus standard enteral nutrition or other enteral nutrition without arginine(control group)for trauma patients were collected.After literature screening,data extraction and quality evaluation with bias risk evaluation tool of Cochrane System Evaluator Manual 5.1.0,Meta-analysis was performed by using Rev Man 5.3 statistical software.RESULTS:Totally 13 RCTs were included,involving 777 patients.Results of Meta-analysis showed that fatality rate[RR=1.67,95% CI(1.07,2.61),P=0.03],IgG[MD=2.81,95% CI(0.43,5.18),P=0.02],IgM[MD=0.30,95% CI(0.07,0.54),P=0.01],CD4+[MD=5.05,95% CI(2.55,7.56),P<0.000 1]and CD4+/CD8+[MD=0.27,95% CI(0.11,0.44),P=0.001]in trial group were significantly higher than control group;the level of serum albumin[MD=-0.47,95% CI(-0.75,-0.19),P=0.000 9]in trial group was significantly lower than control group.There was no statistical significance in the incidence of infectious complications[RR=0.77,95% CI(0.51,1.17),P=0.22],total hospitalization time[MD=-2.35,95% CI(-10.72,6.02),P=0.58],IgA[MD=0.38,95% CI(-0.06,0.82),P=0.09],CD8+[MD=-2.49,95% CI(-6.01,1.03),P=0.17]or the incidence of ADR between 2 groups.CONCLUSIONS:Arginine-supplemented enteral nutrition can improve the immune function of trauma patients,but increase mortality.It is necessary to be cautious in clinical use.

关 键 词：精氨酸 强化 肠内营养 创伤 预后 免疫功能 META分析 

分 类 号：R969.3[医药卫生—药理学]