运动和营养干预对结直肠癌相关性肌少症影响的Meta分析

The impact of exercise and nutrition intervention in colorectal cancer-related sarcopenia:a Meta-analysis

目的系统评价运动和营养干预对结直肠癌患者肌力、肌量、躯体功能及肌少症发生率的影响,以期为临床干预结直肠癌相关性肌少症提供依据。方法检索PubMed、Embase、Web of Science、The Cochrane Library、维普期刊数据库、万方期刊数据库、中国知网和中国生物医学文献数据库,检索时段为建库至2021-07-01,严格按纳入排除标准筛选文献,对纳入文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果纳入10篇随机对照试验,试验组样本量350例,对照组353例,其中试验组为运动联合营养干预的研究3项,运动干预的研究3项,营养干预的研究4项。Meta分析结果显示,与常规护理相比,运动联合营养干预对提高结直肠癌患者的下肢肌力[均数差(MD)=4.50,95%CI:1.92~7.08,P<0.001]、肌量[标准化均数差值(SMD)=0.43,95%CI:0.01~0.86,P=0.050]和躯体功能SMD=41.60,95%CI:20.08~63.12,P<0.001差异有统计学意义;营养干预对减少结直肠癌患者肌少症发生率差异有统计学意义[相对风险度(RR)=0.69,95%CI:0.50~0.94,P=0.020]。结论运动联合高蛋白营养能改善结直肠癌患者的肌力、肌量和躯体功能,营养干预降低了结直肠癌患者的肌少症发生率,但因纳入研究的数量不多且质量中等,建议开展高质量、大样本的随机对照研究进一步验证。

Objective To systematically evaluate the effects of exercise and nutrition intervention on muscle strength,muscle mass,physical performance and the incidence of sarcopenia in colorectal cancer patients,in order to provide a basis for clinical intervention in colorectal cancer-related sarcopenia.Methods The published papers related to intervention for colorectal cancer-related sarcopenia were searched in the PubMed,Embase,Web of Science,The Cochrane Library,VIP,Wanfang data,CNKI,and CBM databases from establishment of the database to July 1,2021.After literature screening and quality evaluation,data were extracted for meta-analysis by RevMan 5.3.Results There were 10 randomized controlled trials with 350 sample cases in experimental group and 353 in control group,including 3 studies of exercise combined with nutrition intervention,3 studies of exercise intervention,and 4 studies of nutrition intervention.Meta-analysis results showed that,compared with conventional care,exercise combined with nutrition intervention significantly improved the patients’legs muscle strength(MD=4.50,95%CI:1.92-7.08,P<0.001),muscle mass(SMD=0.43,95%CI:0.01-0.86,P=0.050)and physical performance(SMD=41.60,95%CI:20.08-63.12,P<0.001);Nutrition intervention can significantly reduce the incidence of sarcopenia in patients with colorectal cancer(RR=0.69,95%CI:0.50-0.94,P=0.020).Conclusions Exercise combined with high protein nutrition can improve the muscle strength,muscle mass and physical performance in patients with colorectal cancer;nutrition intervention can reduce the incidence of sarcopenia in patients with colorectal cancer.However,because of the small-number and medium-quality of the included studies,the conclusion needs to be confirmed by a large-number and high-quality randomized controlled trial.