ω-3不饱和脂肪酸乳剂在肠外营养中对胃肠道恶性肿瘤术后短期疗效的meta分析

Short-Term Efficacy of Omega-3 Polyunsaturated Fatty Acid-Supplemented Parenteral Nutrition in Postoperative Gastrointestinal Malignancy:A Meta Analysis of Randomized Control Trials

目的系统评价ω-3不饱和脂肪酸乳剂在肠外营养中对胃肠道恶性肿瘤术后的短期疗效的影响。方法检索Pub Med、Embase、Scopus、Cochrane Library、CNKI、维普、万方数据库等中英文数据库(所有文献检索截止2015年1月)中关于ω-3不饱和脂肪酸乳剂肠外营养对于胃肠道恶性肿瘤患者术后影响免疫方面疗效的随机对照试验的文献,用Cochrane协作网提供的方法评价文献质量,对纳入的研究文献进行数据提取并核对,采用Rev Man 5.3进行meta分析。结果共纳入16篇随机对照试验,总计1 019例患者,补充ω-3不饱和脂肪酸乳剂联合标准肠外营养511例(研究组)和标准肠外营养508例(对照组)。meta分析结果显示:1对细胞免疫水平的影响:研究组CD3、CD4、CD4/CD8细胞比例较对照组明显升高,差异均有统计学意义〔CD3:WMD=6.09,95%CI(2.40,9.77),P=0.001;CD4:WMD=5.25,95%CI(3.30,7.20),P<0.000 01;CD4/CD8:WMD=0.40,95%CI(0.22,0.58),P<0.000 1〕。2对体液免疫水平的影响:研究组Ig A、Ig G水平均明显高于对照组〔Ig A:WMD=0.56,95%CI(0.36,0.77),P<0.000 0 1;Ig G:WMD=2.88,95%CI(0.63,5.13),P=0.01〕。3对淋巴细胞计数的影响:研究组明显高于对照组〔WMD=0.27,95%CI(0.10,0.43),P=0.002〕。4对细胞因子水平的影响:研究组IL-6、TNF-α水平明显低于对照组〔IL-6:WMD=-16.75,95%CI(-25.00,-8.50),P<0.000 1;TNF-α:WMD=-6.25,95%CI(-10.55,-1.95),P=0.004〕。5术后感染性并发症发生率:研究组明显低于对照组〔OR=0.36,95%CI(0.20,0.66),P=0.000 8〕。结论对于胃肠道恶性肿瘤手术的患者,术后肠外营养应用ω-3不饱和脂肪酸乳剂干预能改善术后免疫功能,减少术后炎症反应,降低术后感染性并发症的发生率,能提高术后近期疗效。

Objective To systematically evaluate short-term efficacy of omega-3（ω-3） polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy.Methods The literatures published randomized control trials（RCT） were searched in PubMed,Embase,Scopus,Cochrane Library,CNKI,Weipu,and Wanfang Databases.The immune efficacy outcomes of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared.All the relevant studies were screened and the data were extracted before January 2015.The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library.Statistical analysis was performed by RevMan 5.3 software.Results Sixteen RCTs involving 1 019patients（511 in the study group,508 in the control group） were enrolled into the analysis.The results of meta analysis：① In the cell immunity：The proportions of CD3,CD4,CD4/CD8 in the study group were significantly higher than those in the control group[CD3：WMD=6.09,95%CI（2.40,9.77）,P=0.001;CD4：WMD=5.25,95%CI（3.30,7.20）,P〈0.000 01;CD4/CD8：WMD=0.40,95%CI（0.22,0.58）,P0.000 1）.② In the humoral immunity：The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA：WMD=0.56,95%CI（0.36,0.77）,P〈0.0000 1;IgG：WMD=2.88,95%CI（0.63,5.13）,P=0.0l）.③ The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27,95%CI（0.10,0.43）,P=0.002）.④ In the cytokines：The levels of interleukin-6and tumor necrosis factor（TNF）-α in the study group were significantly lower than those in the control group[interleukin-6：WMD=- 16.75,95%CI（- 25.00,- 8.50）,P〈0.000 1;TNF-α：WMD=- 6.25,95%CI（- 10.55,- 1.95）,P=0.004）.⑤ The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36,95%CI（0.20,0.66）,P=0.000 8）.Conclusion For postoperative patients with gastrointestinal malignancy,ω-3polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function,decrease postoperative inflammatory reaction,and reduce rate of infective complications.