omega-3脂肪酸用于肿瘤恶液质患者口服营养补充的meta分析

Meta-analysis of the use of oral nutritional supplements containing omega-3 fatty acids for patients with cancer cachexia

目的系统评价omega-3脂肪酸用于肿瘤恶液质患者口服营养补充(ONS)的临床疗效。方法全面检索PubMed、EMbase、Web of Science、中国知网、万方数据库和SinoMed等数据库,搜索关于含omega-3脂肪酸营养补充治疗肿瘤恶液质患者的随机对照试验。检索时间为2000年1月1日至2020年7月4日。对符合纳入标准的研究进行质量评价,按照Cochrane 5.1手册标准及改良的Jadad评分量表对纳入的研究进行偏倚风险评估和文献质量评价,最后应用RevMan5.3软件进行数据合并及meta分析。结果初筛获得316篇文献,通过阅读标题和摘要进一步筛选获得54篇文献,最终纳入7项随机对照试验,共901例患者。Meta分析结果显示:含omega-3脂肪酸营养补充与对照组相比,患者体重明显增加(MD=2.4kg,95%CI=2.262.53kg,P<0.001);生活质量明显改善(MD=4.71,95%CI=3.995.42,P<0.001)。然而患者的去脂体重与对照组相比,无显著差异(MD=-0.79kg,95%CI=-2.090.51,P=0.23);生存时间定性分析结果显示,含omega-3脂肪酸的ONS并不能延缓肿瘤恶液质病程,也不能延长患者生存时间。结论含omega-3脂肪酸的口服营养补充有可能改善肿瘤恶液质患者的生活质量。

Objective To systematically evaluate the clinical efficacy of oral nutritional supplements of omega-3 fatty acids in patients with cancer cachexia.Methods PubMed,EMbase,SinoMed,Web of Science,CNKI and Wanfang Data databases were comprehensively searched to collect randomized controlled trial on oral nutritional supplements containing omega 3 Fatty Acids for cancer cachexia from January 1,2000 until July 4,2020.Two reviewers independently screened literature based on inclusion and exclusion criteria,and then evaluated the risk of bias and literature quality of the included studies in accordance with the Cochrane Handbook of Systematic Reviews of Interventions and the modified Jadad scoring scale.Finally,meta-analysis was performed using Revman 5.3 software.Results A total of 316 potential related articles were searched and 54 articles were obtained after preliminary screening.Finally,we determined a total of 7 randomized controlled trials(RCTs)involving 901 patients.The result of meta-analysis showed that:compared with placebo group,oral nutritional supplements containing omega 3 Fatty Acids significantly put on weight(MD=2.4kg,95%CI=2.26-2.53,P<0.001)and improve the quality of life(MD=4.71,95%CI=3.99-5.42,P<0.001).However,lean body mass showed no statistically significant difference between the two groups(MD=﹣0.79,95%CI=-2.09-0.51),P=0.23;Qualitative analysis of survival time showed that ONS containing omega-3 fatty acids could not delay the course of cachexia and prolong the survival time of patients.Conclusion Oral nutritional supplements containing omega-3 fatty acids have the potential to improve the quality of life in patients with cancer cachexia.