早产儿补充长链多不饱和脂肪酸对支气管肺发育不良和坏死性小肠结肠炎发生率影响的系统评价和Meta分析

The impact of LCPUFA supplement on incidence of necrotizing enterocolitis and bronchopulmonary dysplasia in preterm infants : a systematic review and meta-analysis

目的定量评价早产儿补充长链多不饱和脂肪酸（LCPUFA）能否降低坏死性小肠结肠炎（NEC）、支气管肺发育不良（BPD）等的发生率。方法计算机检索Pub Med、EMBASE、the Cohrane Library、万方数据库和中国知网,获得早产儿补充LCPUFA对NEC、BPD、严重感染（败血症）和病死率影响的RCT文献,检索时限均从建库至2015年8月27日。由2名研究者独立行文献筛选、资料提取,采用改良JADAD量表评价纳入文献的偏倚风险。以相对危险度（RR）及其95%CI作为效应指标。采用Rev Man 5.3软件行Meta分析,根据异质性检验结果选择相应的效应模型合并效应量。结果 15篇RCT文献（n=2 658）进入Meta分析。13篇文献JADAD评分5~7分,2篇文献〈5分,总体偏倚风险不大。Meta结果显示,早产儿补充与未补充LCPUFA组的NEC、BPD、严重感染（败血症）和病死率差异均无统计学意义,其RR及其95%CI分别为1.16（0.73~1.83）、0.94（0.79~1.13）、1.13（0.93~1.37）和1.15（0.56~2.36）。以胎龄行亚组分析,胎龄≤32周早产儿补充和未补充LCPUFA的NEC发生率差异有统计学意义,RR=0.42（95%CI：0.19~0.96）,BPD和严重感染（败血症）发生率在胎龄≤32周早产儿补充和未补充LCPUFA间差异均无统计学意义。结论早产儿补充LCPUFA不能降低BPD、严重感染（败血症）的发生率和病死率,可能降低胎龄≤32周早产儿NEC发生率。

Objective To compare the incidence of necrotizing enterocolitis（ NEC）,bronchopulmonary dysplasia（ BPD） and other neonatal disease between preterm infants received LCPUFA-supplemented formula and regular formula. Methods The databases of Pub Med,EMBASE,the Cohrane Library,CNKI and Wanfang database were searched from establishment to Augest,2015,to collect relevant studies investigating the impact of preterm infants given LCPUFA on the incidence of NEC,BPD,sepsis and mortality.Two reviewers independently screened literatures,extracted data,and assessed the risk bias of included studies by modified JADAD scale,including randomization,concealing,blinding and loss of follow up. The outcomes were expressed as risk ratio（ RR） with95% CI. The meta-analysis was performed using Rev Man 5. 3 software. A fixed-effect model or a random-effect model would be used according to the heterogeneity test results. Results Fifteen RCTs（ 2 658 infants） were included into this meta-analysis. The JADAD score of 13 RCTs ranged from 5 to 7,whearas 2 RCTs 5,which indicated the risk of bias of included studies was low. The metaanalysis showed that LCPUFA could not significantly decrease the incidence of NEC,BPD,sepsis or death,the correponding RR（ 95% CI） was 1. 16（ 0. 73- 1. 83）,0. 94（ 0. 79- 1. 13）,1. 13（ 0. 93- 1. 37） and 1. 15（ 0. 56- 2. 36）,respectively. Subgroup analysis found that preterm infants with gestational age ≤32 weeks receiving LCPUFA had lower incidence of NEC（ RR,0. 42,95% CI： 0. 19- 0. 96）. The incidences of BPD and sepsis did not significantly differ in infants reveiving and non-reveiving LCPUFA in the gestational age ≤32 weeks. Conclusion Preterm infants received LCPUFA-supplemented formula could not decrease the incidence of BPD,sepsis and death,however may decrease the incidence of NEC in infants with gestational age less than 32 weeks.