术前肠内免疫营养治疗对结直肠癌术后病人临床疗效和安全性影响的Meta分析及GRADE评价  

Effect of preoperative enteral immunonutrition on clinical efficacy and safety of postoperative patients with colorectal cancer:a Meta-analysis and GRADE evaluation

作　　者：李晓倩 关华[2] 徐小陶 丁林飞 LI Xiaoqian;GUAN Hua;XU Xiaotao;DING Linfei(School of Nursing,Chengdu University of Traditional Chinese Medicine,Sichuan 610075 China)

机构地区：[1]成都中医药大学护理学院,四川610075 [2]四川省医学科学院·四川人民医院(电子科技大学附属医院)健康管理中心 [3]电子科技大学医学院

出　　处：《循证护理》2024年第2期191-201,共11页Chinese Evidence-Based Nursing

基　　金：四川省医疗卫生与健康促进会2022年度青年科研项目,编号:KY2022QN0065。

摘　　要：目的:系统评价术前肠内免疫营养对结直肠癌病人的疗效,以期为临床营养治疗提供参考依据。方法:计算机检索PubMed、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang Database)、维普数据库(VIP)中关于结直肠癌病人接受术前肠内免疫营养的随机对照试验(RCT)。检索时限均为建库至2023年4月7日。由2位评审人员依据纳入及排除标准分别筛选文献、提取数据及质量评价,采用RevMan 5.4软件进行Meta分析。结果:共纳入16篇文献,涉及1462例病人。Meta分析结果显示,两组CD8^(+)水平、非感染性并发症发生率比较,差异无统计学意义(P均>0.05)。相较于对照组,试验组可提高IgA水平[MD=0.47,95%CI(0.16,0.79),P=0.003]、IgG水平[MD=2.03,95%CI(1.34,2.71),P<0.0001]、IgM水平[MD=0.24,95%CI(0.09,0.39),P=0.001]、CD4^(+)水平[MD=2.81,95%CI(2.19,3.44),P<0.0001]、CD4^(+)/CD8^(+)水平[MD=0.15,95%CI(0.10,0.20),P<0.00001]、血红蛋白水平[MD=9.11,95%CI(0.74,17.49),P=0.03]、血清清蛋白水平[MD=2.27,95%CI(0.92,3.61),P=0.001]及前清蛋白水平[MD=52.35,95%CI(15.21,89.50),P=0.006],可降低感染性并发症总发生率[RR=0.46,95%CI(0.28,0.73),P=0.001]、切口感染发生率[RR=0.60,95%CI(0.40,0.89),P=0.01]及肺部感染发生率[RR=0.38,95%CI(0.16,0.88),P=0.02]。GRADE系统评价结果显示,证据质量水平IgG、CD4^(+)/CD8^(+)、感染并发症总发生率、切口感染发生率、肺部感染发生率、非感染性并发症发生率为中级,IgA、IgM、CD4^(+)、CD8^(+)、血清清蛋白为低级,血红蛋白、前清蛋白为极低级。结论:现有证据表明,结直肠癌术后病人应用术前肠内免疫营养可有效提高病人体液免疫功能、细胞免疫功能,改善营养状况,降低感染性并发症发生率。Objective:To systematically evaluate the effect of preoperative enteral immunonutrition on patients with colorectal cancer,in order to provide reference for clinical nutritional treatment.Methods:RCTs of preoperative enteral immunonutrition in patients with colorectal cancer were retrieved from PubMed,Web of Science,EMbase,CBM,CNKI,WanFang Database,VIP.The search deadline was from database establishment to April 7,2023.According to the inclusion and exclusion criteria,two reviewers screened the literature,extracted data,and evaluated the quality.RevMan 5.4 software was used for Meta-analysis.Results:A total of 16 articles were included,involving 1462 patients.The Meta-analysis results showed that there was no statistically significant difference(P>0.05)in CD8^(+)levels and the incidence of non infectious complications between the two groups.Compared with the control group,the experimental group can increase the levels of IgA(MD=0.47,95%CI 0.16-0.79,P=0.003),IgG(MD=2.03,95%CI 1.34-2.71,P<0.0001),IgM(MD=0.24,95%CI 0.09-0.39,P=0.001),CD4^(+)(MD=2.81,95%CI 2.19-3.44,P<0.0001),CD4^(+)/CD8^(+)(MD=0.15,95%CI 0.10-0.20,P<0.00001),hemoglobin(MD=9.11,95%CI 0.74-17.49,P=0.03),serum albumin(MD=2.27,95%CI 0.92-3.61,P=0.001),and prealbumin(MD=52.35,95%CI 15.21-89.50,P=0.006),which can reduce the overall incidence of infectious complications(RR=0.46,95%CI 0.28-0.73,P=0.001),incision infections(RR=0.60,95%CI 0.40-0.89,P=0.01),and lung infections(RR=0.38,95%CI 0.16-0.88,P=0.02).The results of GRADE systematic review showed that the quality of evidence level of IgG,CD4^(+)/CD8^(+),total infection complication rate,incision infection rate,lung infection rate,and total non-infection complication rate were medium;IgA,IgM,CD4^(+),CD8^(+),serum albumin were low;and hemoglobin and prealbumin were very low.Conclusion:The existing evidence shows that preoperative enteral immunonutrition can effectively improve the humoral and cellular immune functions,improve the nutritional status and reduce the incidence of infectious complications in p

关 键 词：免疫营养 肠内营养 结直肠癌 META分析 循证护理 

分 类 号：R473.73[医药卫生—护理学]