营养支持对鼻咽癌放疗患者影响的meta分析

Effect of nutritional support on nasopharyngeal carcinoma patients with radiotherapy:a meta-analysis

目的系统评价营养支持对鼻咽癌放疗患者预后的影响,为预防鼻咽癌放疗后并发症和副作用提供依据。方法系统检索中国知网、万方数据库、中国生物医学文献数据库、Web of Science、PubMed、the Cochrane Library、EMbase等数据库中2004年1月—2019年6月发表的营养支持对鼻咽癌放疗患者影响相关文献,在Stata 12.0软件上进行meta分析,应用Q和I^2统计量进行异质性检验,漏斗图评估发表偏倚。结果共纳入13项随机对照研究,总样本量1296例。meta分析结果显示:经营养支持鼻咽癌放疗患者组的BMI[OR=0.325,95%CI(0.107,0.991)]、血红蛋白[SMD=0.926,95%CI(0.56,1.293)]、白蛋白[SMD=0.726,95%CI(0.479,0.973)],及放射性皮肤反应(Ⅲ~Ⅳ级)[OR=0.242,95%CI(0.171,0.343)]均优于对照组(未经营养支持组)。口咽黏膜损伤(3~4级)发生率[OR=0.929,95%CI(0.576,1.479)]无统计学差异。结论营养支持对于维持鼻咽癌患者在放疗期间的营养学指标具有积极的作用,且降低了急性放射性皮炎(Ⅲ~Ⅳ级)发生的风险。而营养支持是否能降低口腔黏膜损伤目前不能明确,有待进一步研究。

Objective To systematically evaluate the effect of nutritional support on the prognosis of nasopharyngeal carcinoma(NPC)patients with radiotherapy so as to provide a basis for prevention of complications and side effects after radiotherapy for NPC.Methods We systematically searched literatures referring to the effects of nutritional intervention on NPC patients with radiotherapy issued from January,2004 to June,2019 in the databases of China National Knowledge Infrastructure(CNKI),WanFang,VIP,Web of Science,PubMed,the Cochrane Library and EMbase.Meta-analysis was performed using Stata 12.0 software,Q-test and I^2 statistic were used to evaluate the heterogeneity between the results of the study using the Stata 12.0 software,and the funnel plot was used to evaluate publication bias.Results Thirteen randomized controlled trials were included in this analysis,involving a total of 1,296 cases.Meta-analysis showed that body mass index(OR=0.325,95%CI:0.107-0.991),hemoglobin(SMD=0.926,95%CI:0.56-1.293),albumin(SMD=0.726,95%CI:0.479-0.973)and radioactive skin reaction(gradesⅢ-Ⅳ)(OR=0.242,95%CI:0.171-0.343)in the nutritional support group of NPC patients with radiotherapy were superior to those in the control group(the non-nutritional support group).No statistically significant difference was found in the incidence rate of oropharyngeal mucosal injury(grades III-IV)(OR=0.929,95%CI:0.576-1.479).Conclusions Nutritional support plays a positive role in maintaining the nutritional parameters of NPC patients during radiotherapy;moreover,it reduces the risk of acute radiation skin reaction(gradesⅢ-Ⅳ).However,its impact on the reduction of oral mucosal injury is not yet clear and needs more studies.