益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果的Meta分析  

Probiotics combined with enteral nutrition versus enteral nutrition alone in improving the prognosis of patients with gastric cancer surgery

作　　者：刘洋[1] 张利龙 袁启航 许尧 胡雨奇 金祺 梅迪[1] 张瑶 申爽[1] 李明[2] LIU Yang;ZHANG Li-long;YUAN Qi-hang;XU Yao;HU Yu-qi;JIN Qi;MEI Di;ZHANG Yao;SHEN Shuang;LI Ming(Central Hospital of Huludao City,HuLudao,Liaoning 125000,China;不详)

机构地区：[1]葫芦岛市中心医院检验科,辽宁125000 [2]大连医科大学

出　　处：《中国微生态学杂志》2021年第5期506-512,共7页Chinese Journal of Microecology

基　　金：辽宁省自然科学基金(2015020262);大连市科技创新基金(2020JJ27SN068)。

摘　　要：目的对益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果进行Meta分析,以得出综合评价结论。方法利用PubMed、Cochrane、Embase、CNKI、维普和万方数据库进行文献检索,搜集有关益生菌联合肠内营养对比单用肠内营养改善胃癌手术患者预后效果的随机对照试验,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,应用RevMan 5.3分析软件进行Meta分析。结果最终纳入8个临床随机对照试验,共552例患者。Meta分析显示,与仅用肠内营养相比,益生菌联合肠内营养能更有效地降低胃癌患者术后血清内毒素水平[MD=-15.94,95%CI(-27.40,-4.49),P=0.006]、血清TNF-α水平[MD=-9.25,95%CI(-14.51,-3.99),P<0.001]、术后腹泻发生率[OR=0.41,95%CI(0.20,0.83),P=0.010];缩短术后住院天数[MD=-1.62,95%CI(-2.78,-0.46),P=0.006];提高淋巴细胞[MD=0.24,95%CI(0.07,0.42),P=0.007],粪便双歧杆菌[MD=1.94,95%CI(0.71,3.17),P=0.002]和乳杆菌[MD=2.21,95%CI(0.69,3.74),P=0.004]计数水平。益生菌还有增加胃癌患者术后血清IgG[MD=2.37,95%CI(-0.32,5.06),P=0.080]和IgM[MD=0.73,95%CI(-0.35,1.82),P=0.190]水平的趋势,但差异无统计学意义。结论当前证据表明,益生菌联合肠内营养治疗胃癌术后临床疗效确切,远优于仅用肠内营养,可以增强胃癌患者术后的机体免疫力、降低感染和腹泻的发生率、减轻全身炎性反应、维持肠道微生态的平衡,促进患者康复。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the effects of probiotics combined with enteral nutrition versus enteral nutrition alone in improving the prognosis of patients with gastric cancer after operation.Methods Electronic databases including PubMed,Cochrane,Embase,CNKI,VIP and WanFang Data were searched.Randomized control trials(RCTs)of probiotics combined with enteral nutrition versus enteral nutrition alone to improve the prognosis of patients with gastric cancer after operation were collected.Two researchers independently selected the literatures,extracted the data and evaluated the risk of bias in the included study,then applied RevMan 5.3 analysis software for meta-analysis.Results A total of 8 RCTs involving 552 patients were included.The results of our study showed that compared with enteral nutrition alone,probiotics combined with enteral nutrition could more effectively reduce serum endotoxin[MD=-15.94,95%CI(-27.40,-4.49),P=0.006],TNF-α[MD=-9.25,95%CI(-14.51,-3.99),P<0.001],incidence of postoperative diarrhea[OR=0.41,95%CI(0.20,0.83),P=0.010],shorten the days of postoperative hospital stays[MD=-1.62,95%CI(-2.78,-0.46),P=0.006],and increase lymphocyte count[MD=0.24,95%CI(0.07,0.42),P=0.007],Bifidobacterium[MD=1.94,95%CI(0.71,3.17),P=0.002]and Lactobacillus[MD=2.21,95%CI(0.69,3.74),P=0.004].Probiotics also tended to increase serum IgG[MD=2.37,95%CI(-0.32,5.06),P=0.080]and IgM[MD=0.73,95%CI(-0.35,1.82),P=0.190],but the difference was not statistically significant.Conclusion Probiotics combined with enteral nutrition exert a significant effect in the treatment of patients after gastric cancer operation,with far better clinical outcomes than enteral nutrition alone.It can enhance the immunity,reduce the incidence of infection and diarrhea,reduce systemic inflammatory response,maintain the balance of intestinal microbiology,and promote patients′recovery.Limited by the quality of the included studies,the above conclusion need to be verified by more high-quality researches.

关 键 词：益生菌 肠内营养 胃癌 META分析 

分 类 号：R378[医药卫生—病原生物学]