谷氨酰胺强化肠内营养对胃癌术后免疫功能影响的Meta分析

Meta- analysis of the effect of glutamine enhanced enteral nutrition on immune function in patients with gastric cancer

目的:系统评价国内谷氨酰胺强化肠内营养对胃癌患者术后免疫功能的影响。方法:计算机检索中国生物医学文献数据库、中国学术期刊全文数据库、数字化期刊全文数据库,同时辅以其他检索,收集所有关于谷氨酰胺强化肠内营养对胃癌患者术后免疫功能影响的随机对照试验,检索时限均从建库至2013年10月。由2名评价员按照纳入标准筛选文献、提取资料和评价质量后,采用Rev Man5.2软件进行Meta分析。结果:共有5篇随机对照试验(RCT)符合纳入标准(307例患者)。Meta分析结果显示:谷氨酰胺强化肠内营养组免疫指标CD4、CD8、CD4/CD8、Ig G、Ig M在胃癌术后7-10天均高于常规肠内营养组,其MD和95%CI分别为[4.87,(2.87,6.88)]、[1.85,(0.15,3.55)]、[0.20,(0.06,0.34)]、[1.06,(0.48,1.64)]、[0.11,(0.03,0.19)],其差异有统计学意义(P<0.05)。而两组肠内营养在免疫指标Ig A方面差异无统计学意义(P>0.05)。谷氨酰胺强化肠内营养组术后住院天数低于常规肠内营养组,MD和95%CI为[-1.31,(-2.22,-0.41)],其差异有统计学意义(P<0.05)。两组肠内营养在术后并发症和肛门排气时间的差异无统计学意义(P>0.05)。结论:含谷氨酰胺的肠内营养可以改善和增强胃癌患者术后应激状态下的免疫功能。

Objective：To evaluate the impact of the glutamine enhanced enteral nutrition on immune function for the gastric cancer. Methods：Data bases CBM,CNKI,WanFang Data were searched,and other sources were also re-trieved to collect the randomized controlled trials（RCTs）about glutamine on immune function published. After litera-ture screening,data extraction and quality evaluation performed by two reviewers independently according to the inclu-sion criteria,the Meta - analysis was conducted using RevMan5. 2 software. Results：A total of five randomized con-trolled trials involving 307 patients were included in the study. The results of Meta - analysis showed：The immune pa-rameters of glutamine enhanced enteral nutrition such as CD4,CD8,CD4 ∕ CD8,IgG,IgM were significantly higher than conventional enteral nutrition after 7 to 10 days of gastric surgery. Its MD and 95 % CI were[4. 87,（2. 87, 6. 88）],[1. 85,（0. 15,3. 55）],[0. 20,（0. 06,0. 34）],[1. 06,（0. 48,1. 64）],[0. 11,（0. 03,0. 19）]. The difference between two groups enteral nutrition had no statistical significance in immune parameters IgA. The hospital stay of glutamine enhanced enteral nutrition were significantly lower than conventional enteral nutrition,the MD and 95% CI were[ - 1. 31,（ - 2. 22,- 0. 41）]. But the postoperative complications and the time to first flatus showed no significant difference between two groups. Conclusion：Glutamine in enteral nutrition for patients with gastric cancer can improve and enhance the immune function under stress.