添加ω-3多不饱和脂肪酸的营养支持对消化系统恶性肿瘤患者免疫与营养状况作用的Meta分析

Effect of ω-3 polyunsaturated fattty acids-supplemented nutrition support on immune function and nu- tritional status of patients with gastrointestinal malignant tumor： a meta-analysis

目的系统评价添加ω-3多不饱和脂肪酸的营养支持对消化系统恶性肿瘤患者免疫功能与营养状况的影响。方法检索MEDLINE、EIBASE、Cochrane对照试验中心注册数据库（CENTRAL）、中国知网（CNKI）和中国生物医学文献数据库（CBM），检索起止时间为数据库默认时间。检索主题词选择omega-3 fatty acids、fish oil、cancer、tumor、neoplasms、ω-3多不饱和脂肪酸、鱼油、恶性肿瘤和癌症。采用Jadad量表进行研究质量评价，筛选出高质量随机对照试验。采用RevMan5．2统计软件进行分析，研究ω-3多不饱和脂肪酸对消化系统恶性肿瘤患者免疫和营养指标的影响。结果共纳入12项高质量随机对照试验。Meta分析结果显示，ω-3多不饱和脂肪酸支持组的CD4＋％（I^2=0％，95％CI=3．44-6．93，Z=5．82，P〈0．00001）、CD8＋％（I^2=0％，95％ CI=2．44～7．13，Z=4．00，P〈0．0001）、CD4＋％／CD8＋%（I^2=74％，95％CI=0．16～0．83，Z=2．87，P=0．004）、IgA（I^2=14％，95％CI：0．21—0．43，Z=5．84，P〈0．00001）、血清前白蛋白水平（I^2=0％，95％CI：0．02—0．05，Z=3．94，P〈0．0001）显著高于常规营养支持组，C反应蛋白水平显著低于常规营养支持组（I^2=76％，95％CI=-21．33～-5．03，z=3．17，P=0．002）；CD3＋％（I^2=0％．95％CI=-3．50—2．56，Z=0．31，P=0．76）、IgC（I^2=92％，95％CI=-0．32—5．54，z=1．74，P=0．08）、IgM（I^2=99％，95％CI=-0．52-1．89，z=1．11，P-0．27）、血清总蛋白（I^2=0％，95％CI=-4．08～1．77，z=0．78，P=0．44）、白蛋白（I^2=29％，95％CI：-0．87～1．45，z=0．49，P=0．63）和转铁蛋白（12=0％，95％CI=-0．23—0．19，Z=0．19，P=0．85）的组间差异无统计学意义。结论ω-3多不饱和脂肪酸可提高消化系统恶性肿瘤患者围手术期的免疫功能，减轻炎性与应激反应，但对营养状况的改善效果不明显。

Objective To systematically review the effect of co-polyunsaturated fatty acids-supplemented nutrition support on the immune function and nutritional status of patients with gastrointestinal malignancies. Methods Databases of MEDLINE, EMBASE, Cochrance Central register of controlled trials, China National Knowledge Infrastructure （CNKI）, China Biology Medicine disc （CBM） were searched. The search wordswere omega-3 polyunsaturated fatty acids, fish oil, cancer, turmor, neoplasms in English or Chinese. All the high quality randomized controlled trials were included after assessed with Jadad scale. RevMan 5. 2 was used for statistical analysis. Results Altogether 12 studies were included. Meta-analysis results showed that CD4＋% （I^2 =0%,95% CI=3.44-6.93, Z=5.82, P〈0. 00001）, CD8＋% （I^2=0%,95% CI=2.44 7.13, Z=4.00, P 〈0.000 1）, CD4＋%/CD8＋% （I^2 =74%, 95% CI=0.16 ~0.83, Z=2.87, P= 0.004）, IgA （I^2 =14%, 95% CI=0.21 ~0.43, Z=5.84, P〈0.00001）, prealbumin （I^2=0%, 95% CI = 0. 02 - 0. 05, Z = 3.94, P 〈 0. 000 1 ） in the treatment group were higher than in the control group, C-re- active protein （I^2 = 76% , 95% CI = - 21.33 -- 5.03, Z = 3. 17, P = 0. 002） in the treatment group was lower than in the control group, the differences were all statistically significant. But there were no statistically significant differences inCD3＋% （I^2 =0%, 95% CI= -3.50 -2.56, Z=0.31, P=0.76）, IgG （I^2 = 92%, 95% CI= -0.32~5.54, Z=1.74, P=0.08）, IgM （I^2 =99%, 95% CI= -0.52-1.89, Z= 1.11, P=0.27）, total protein （I^2 =0%, 95%CI= -4. 08-1.77, Z=0.78, P=0.44）, albumin （I^2 = 29%, 95% CI= -0.87-1.45, Z=0.49, P=0.63）, transferrin （I^2 =0%, 95% CI= -0.23 ~0.19, Z = 0. 19, P = 0. 85 ） between treatment and control groups. Conclusion Omega-3 polyunsaturated fatty acids can improve the perioperative immune function of patients with gastrointestinal malignant tumor, reduce inflam- matory and stress reactions, but have no obvious effect on the improvement of the nutritional status.