口腔免疫疗法对早产儿干预效果的Meta分析

The effect of oral immune therapy in premature infants: a Meta-analysis

目的 :系统评价口腔免疫疗法对早产儿的干预效果。方法 :计算机检索CochraneLibrary、PubMed、Embase、WebofScience、CINAHL、中国知网、万方、维普等数据库有关早产儿口腔免疫疗法的随机对照试验,按照纳入和排除标准筛选文献、提取资料及评价文献质量,采用RevMan 5.3软件进行分析。结果 :共纳入10项随机对照研究,包括623名早产儿;Meta分析结果显示,初乳组的院内感染[RR=0.35,95%CI(0.17,0.73),P=0.005]、败血症[RR=0.54,95%CI(0.37,0.77),P=0.0007]、喂养不耐受[RR=0.46,95%CI(0.28,0.75),P=0.002]的发生率;经口喂养时间[MD=-2.57,95%CI(-4.84,-0.29),P=0.03]和完全肠道喂养时间[MD=-4.99,95%CI(-8.54,-1.45),P=0.006],与无菌水组/生理盐水组相比,差异有统计学意义;但是坏死性小肠结肠炎[RR=0.54,95%CI(0.22,1.33),P=0.18]的发生率,与无菌水组相比,差异无统计学意义。结论 :口腔免疫疗法可以降低早产儿院内感染、败血症及喂养不耐受的发生率,缩短其经口喂养时间和完全肠道喂养时间。但是对坏死性小肠结肠炎的发病率无影响。由于不同指标纳入研究不足,故需要大样本、高质量的研究进一步评价口腔免疫疗法对早产儿的干预效果。

Objective： To evaluate the effect of oral immune therapy in premature infants. Methods： We searched Cochrane Library, PubMed, Embase, Web of Science, CINAHL, CNKI, Wanfang, and VIP for RCTs about oral immune therapy in premature infants. We selected studies according to inclusion and exclusion criteria, extracted data and assessed their quality. Data were analyzed by RevMan 5.3. Results： 10 studies with 623 premature infants were included. The results showed that the incidence rates of hospital infection [RR=0.35, 95% CI（0.17, 0.73）, P=0.005], sepsis [RR=0.54, 95% CI （0.37, 0.77）, P=0.0007], and intolerance of enteral feedings [RR=0.46, 95% C1（0.28, 0.75）, P=-0.002] were all significantly different between the sterile or normal saline group and the colostrum group. The days starting oral feeding [MD=-2.57, 95% C1（-4.84, -0.29）, P=-0.03] and the days reaching full enteral feeding [MD=-4.99, 95% C1（-8.54, -1.45）, P=-0.006] were both significantly different, too. However, there were no significant difference in the incidence rate of necrotizing enterocolitis [RR=0.54, 95% CI （0.22, 1.33）, P=-0.18] between these two groups. Conclusion： Oral immune therapy reduced the incidence rate of hospital infection, sepsis and intolerance of enteral feedings, and shorted the days starting oral feeding and the days reaching full enteral feeding. But it did not improve the incidence rate of necrotizing enterocolitis. Due to the insufficiency of studies included, high-quality studies with large sample size are needed to further evaluate the effect of oral immune therapy.