系统评价健脾益气方联合早期肠内营养对胃癌术后患者免疫功能和营养状况的影响

Meta-analysis of the Effect of Jianpiyiqi Decoction Combined with the Early Enteral Nutrition on Immune Function and Nutritional Status of Postoperative Patients with Gastric Cancer

[目的]系统国内评价健脾益气方联合肠内营养对胃癌患者术后免疫功能和营养状况的影响。[方法]检索中国知网(China National Knowledge Infrastructure, CNKI)、万方数据库(Wanfang Data)、维普中文科技期刊数据库(VIP)和中国生物医学文献数据库(China Biomedical Literature, CBM)等,同时辅以其他检索,收集所有健脾益气方联合肠内营养干预胃癌术后患者的临床随机对照试验(randomized controlled trial, RCT),检索时限均从建库至2018年3月。由2名研究员按照纳入标准筛选文献、提取资料和评价质量后,采用RevMan 5.3软件进行Meta分析。[结果]共纳入8个RCT,包括557例患者。Meta分析结果显示,健脾益气方联合肠内营养组(试验组)胃癌术后7～10d免疫指标CD4、CD4/CD8、IgG、IgA、IgM均高于常规肠内营养组(对照组),差异有统计学意义(P﹤0.05);其均数差(mean difference,MD)和95%可信区间(95%confidence interval,CI)分别为[2.87,(1.93～3.81)]、[0.23,(0.166～0.30)]、[2.47,(0.82～4.12)]、[0.52,(0.34～0.69)]、[0.31,(0.10～0.52)]。而试验组CD8低于对照组,其MD和95%CI为[-1.34,95%CI(-2.50～-0.18)],差异有统计学意义(P﹤0.05)。试验组胃癌术后7～10d的营养指标清蛋白、前清蛋白均高于对照组,差异有统计学意义(P﹤0.05),其MD和95%CI分别为[2.35,(1.69～3.01)]、[30.57,(8.33～52.80)]。[结论]健脾益气方联合肠内营养可以增强胃癌术后患者的免疫功能和营养状况。

[Objective]To evaluate the impact of the Jianpiyiqi decoction combined with the early enteral nutrition on immune function and nutritional status of postoperative patients with gastric cancer.[Methods]Domestic data bases CNKI,Wan-Fang,VIP and CBM were searched,and other sources were also retrieved to collect the randomized controlled trials(RCTs) about Jianpiyiqi decoction combined with enteral nutrition on immune-response and nutritional status published.The two researchers independently screened the literature,extracted data,and assessed the risk of bias of included studies.Then metaanalysis was performed using RevMan 5.3 software.[Results]Eight RCTs were enrolled,involving 557 patients.The results of Meta-analysis showed:The immune parameters of Jianpiyiqi decoction combined with enteral nutrition(the experimental group) such as CD4,CD4/CD8,IgG,IgA,IgM were significantly higher than conventional enteral nutrition(the controlled group) after 7 to 10 days of gastric surgery(P﹤0.05).Its MD and 95%CI were[2.87,(1.93~3.81)],[0.23,(0.166~0.30)],[2.47,(0.82~4.12)],[0.52,(0.34~0.69)],[0.31,(0.10~0.52)],but immune parameter of experimental group like CD8 was significantly lower than the controlled group(P ﹤ 0.05),its MD and 95% CI was [-1.34,95% CI(-2.50 ^-0.18)].The nutritional parameters of the experimental group such as Alb,PA were significantly higher than the controlled group after 7 to 10 days of gastric surgery(P﹤0.05).Its MD and 95%CI were [2.35,(1.69 ~3.01)],[30.57,(8.33 ~52.80)].[Conclusion]The Jianpiyiqi decoction combined with the early enteral nutrition can improve immune function and nutritional status with gastric cancer,so as to promote the recovery of patients earlier.