不同肠内免疫营养方案对胃癌术后患者临床结局影响的网状Meta分析

Comparative efficacy of different enteral immunonutrition regimes in patients underwent gastrectomy based on network Meta-analysis

目的:评价不同肠内免疫营养(enteral immunonutrition,EIN)方案对胃癌术后患者临床结局的影响。方法:系统检索不同肠内免疫营养方案与标准肠内营养(standard enteral nutrition,SEN)方案比较,降低胃癌术后患者感染与非感染性并发症发生率及缩短住院时间的随机对照研究(randomized controlled trials,RCTs),经文献筛查、资料提取及偏倚风险评价后,分别采用STATA12.0与WinBUGS1.4软件执行直接比较Meta分析和网状Meta分析(network Meta-analysis,NMA),并采用GRADEpro3.6软件评价证据质量。结果:纳入11项合格RCTs,包括840名患者。直接比较Meta分析表明:与标准肠内营养相比,精氨酸(argnie,Arg)+RNA+ω-3-FAs方案(RR=0.37,95%CI 0.22～0.63;MD=-0.42,95%CI-0.75～-0.07)及Arg+谷氨酰胺(glutamine,Gln)+ω-3脂肪酸(omega-3-fatty acids,ω-3-FAS)方案(RR=0.22,95%CI0.05～0.94;MD=-0.69,95%CI-1.22～-1.070)降低了患者术后感染性并发症,缩短了住院时间。网状Meta分析亦显示:与标准肠内营养相比,Arg+RNA+ω-3-FAs方案(OR=0.27,95%CI 0.12～0.49)和Arg+Gln+ω-3-FAs方案(OR=0.22,95%CI0.02～0.84)降低了患者术后感染性并发症,Arg+Gln+ω-3-FAs方案(SMD=-0.63,95%CI-1.07～-0.13)缩短了住院时间,并且Arg+RNA+ω-3-FAs在降低患者术后感染性并发症方面优于Arg+RNA方案和Arg+Gln方案。结论:Arg+RNA+ω-3-FAs方案与Arg+Gln+ω-3-FAs应作为临床降低胃癌术后患者降低感染性并发症及缩短住院时间的最佳肠内免疫营养方案。

Objective： To assess comparative efficacy of different enteral immunonutrition（EIN） regimes in GC patients underwent gastrectomy. Methods： We performed direct and network Meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition（SEN） in reducing infectious complications（ICs）, noninfectious complications（NICs） and length of hospital stay（LOS）. After screening literatures, abstracting data, and appraising risk of bias of each eligible study, we used STATA version 12.0 and WinBUGS version 1.4 to perform direct and network meta-analysis. The GRADEpro version 3.6 was adopted to grad the level of evidences. Results： We included 11 RCTs, enrolling 840 patients. Pairwise Meta-analysis indicated that argnie（Arg） ＋RNA＋omega-3-fatty acids（ω-3-FAs）（RR=0.37, 95%CI 0.22–0.63; MD=-0.42, 95%CI-0.75 to-0.07）, Arg＋ glutamine（Gln） ＋ω-3-FAs（RR=0.22, 95%CI 0.05–0.94; MD=-0.69, 95%CI-1.22 to-1.07） reduced ICs and LOS, compared with SEN. Network Meta-analysis confirmed the potential of Arg＋RNA＋ω-3-FAs for ICs（OR=0.27, 95%CI 0.12–0.49） and Arg＋Gln＋ω-3-FAs for CIs（OR=0.22, 95%CI 0.02–0.84） and LOS（SMD=-0.63, 95%CI-1.07 to-0.13）, and indicated that Arg＋RNA＋ω-3-FAs was superior to Arg＋RNA and Arg＋Gln for ICs as well, compared with SEN. Conclusion： As for GC patients underwent gastrectomy, Arg＋RNA＋ω-3-FAs and Arg＋Gln＋ω-3-FAs are the optimal regimes of reducing ICs and LOS.