Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis.
Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis.
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接受全胃切除术的胃癌患者的肠内免疫营养与肠内营养：系统评价和荟萃分析
DOI：
10.1186/s12876-018-0741-y
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发表时间：
2018-01-16
影响因子：
2.4
通讯作者：
Zhan Z
中科院分区：
文献类型：
--
作者：
Cheng Y;Zhang J;Zhang L;Wu J;Zhan Z
营养支持是胃癌患者，尤其是择期手术患者的常用手段。近年来，越来越多的研究发现肠内免疫营养（EIN）比肠内营养（EN）更能有效地增强机体免疫功能，从而改善胃癌患者的预后。然而，报告的结果并不一致。本荟萃分析旨在评估EIN对GC患者生化、免疫指标和临床结局的影响。采用四个电子数据库（Medline、EMBASE、Scopus和科克伦图书馆）检索同行评议的英文期刊中的文章。计算平均差（MD）、相对风险（RR）或标准平均差（SMD）及95%置信区间（CI）。用科克伦Q和I2统计量结合相应的P值评估异质性。使用RevMan 5.3进行分析。涉及583例患者的7项研究符合汇总分析的条件。术后超过7天（D ≥ 7）时，EIN患者的CD 4+水平升高（SMD = 0.99; 95% CI，0.65-1.33; P < 0.00001），CD4+/ CD8+（SMD = 0.34; 95% CI，0.02-0.67; P = 0.04），IgM（SMD = 1.15; 95% CI，0.11-2.20; P = 0.03），IgG（SMD = 0.98; 95%CI，0.55-1.42; P < 0.0001）、淋巴细胞（SMD = 0.69; 95%CI，0.32-1.06; P = 0.0003）和前白蛋白（SMD = 0.73; 95%CI，0.33-1.14; P = 0.0004）。但术后7天内（D < 7），上述作用不明显。除前白蛋白外，CD 8+及其他血清蛋白水平在D ≥ 7和D < 7时均无改善。EIN组的全身炎症反应综合征（SIRS）（MD，-0. 89天; 95% CI，-1. 40至-0. 39; P = 0. 005）和术后并发症（RR，0. 29; 95% CI，0. 14 - 0. 60; P = 0. 001）等临床结局显著减少。肺部感染和住院时间（LHS）没有改善，无论手术后的时间。EIN可提高胃癌根治术患者的细胞免疫功能，调节炎症反应，减少术后并发症。灰色文献和非英语语言研究的排除是本研究的关键限制。
Nutrition support is a common means for patients with gastric cancer, especially for those undergoing elective surgery. Recently, enteral immunonutrition (EIN) was increasingly found to be more effective than enteral nutrition (EN) in enhancing the host immunity and eventually improving the prognosis of gastric cancer patients undergoing gastrectomy. However, the results reported were not consistent. This meta-analysis aimed to assess the impact of EIN for patients with GC on biochemical, immune indices and clinical outcomes. Four electronical databases (Medline, EMBASE, Scopus and Cochrane library) were used to search articles in peer-reviewed, English-language journals. Mean difference (MD), Relative risk (RR), or standard mean difference (SMD) with 95% confidence interval (CI) were calculated. Heterogeneity was assessed by Cochrane Q and I2 statistic combined with corresponding P-value. The analysis was carried out with RevMan 5.3. Seven studies involving 583 patients were eligible for the pooled analysis. EIN, when beyond a 7-day time-frame post-operatively (D ≥ 7), increased level of CD4+ (SMD = 0.99; 95% CI, 0.65–1.33; P < 0.00001), CD4+/ CD8+ (SMD = 0.34; 95% CI, 0.02–0.67; P = 0.04), the IgM (SMD = 1.15; 95% CI, 0.11–2.20; P = 0.03), the IgG (SMD = 0.98; 95% CI, 0.55–1.42; P < 0.0001), the lymphocyte (SMD = 0.69; 95% CI, 0.32–1.06; P = 0.0003), and the proalbumin (SMD = 0.73; 95% CI, 0.33–1.14; P = 0.0004). However, those increased effects were not obvious within a 7-day time-frame post-operatively (D < 7). The levels of CD8+ and other serum proteins except proalbumin were not improved both on D ≥ 7 and D < 7. Clinical outcomes such as systemic inflammatory response syndrone (SIRS) (MD, - 0.89 days; 95% CI, - 1.40 to - 0.39; P = 0.005), and postoperative complications (RR, 0.29; 95% CI, 0.14–0.60; P = 0.001) were significantly reduced in EIN group. Pulmonary infection and length of hospitalization (LHS) were not improved no matter what time after surgery. EIN was found to improve the cellular immunity, modulate inflammatory reaction and reduce postoperative complication for GC patients undergoing radical gastrointestinal surgery. Exclusion of grey literature and non-English language studies was the key limitation in this study.
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影响因子：
2.6
作者：
Mochiki, Erito;Ohno, Tetsuro;Kuwano, Hiroyuki
通讯作者：
Kuwano, Hiroyuki
影响因子：
6.3
作者：
Arends, Jann;Bachmann, Patrick;Preiser, Jean-Charles
通讯作者：
Preiser, Jean-Charles
DOI：
10.1186/cc11863
发表时间：
2012-11-23
期刊：
Critical care (London, England)
影响因子：
--
作者：
Schott CK;Huang DT
通讯作者：
Huang DT
影响因子：
4.4
作者：
Bonhomme, Sandra;Belabed, Linda;Darquy, Sylviane
通讯作者：
Darquy, Sylviane
影响因子：
3.5
作者：
Liu, Hua;Ling, Wei;Cao, Hui
通讯作者：
Cao, Hui