初乳对早产儿免疫球蛋白A水平影响的Meta分析

Effect of colostrum on immunoglobulin A levels among premature infants:a meta-analysis

目的系统评价初乳对早产儿免疫球蛋白(IgA)水平的影响,为初乳喂养改善早产儿健康提供依据。方法检索中国知网、万方数据知识服务平台、PubMed和Web of Science等中英文数据库,收集建库至2022年9月30日发表的有关初乳对早产儿IgA水平影响的随机对照试验(RCT)或临床对照试验(CCT)研究文献;以标准化平均差(SMD)作为效应指标进行Meta分析;采用敏感性分析检验结果的稳定性;采用Begg检验、Egger检验和漏斗图评估发表偏倚。结果初期检索文献650篇,最终纳入10篇,其中9篇为RCT,1篇为CCT,样本量为677例。Meta分析结果显示,实施初乳干预的早产儿唾液sIgA水平高于对照组(SMD=0.49,95%CI:0.08~0.89),尿sIgA(SMD=0.19,95%CI:-0.39~0.77)和血IgA水平(SMD=0.29,95%CI:-0.01~0.59)与对照组差异无统计学意义。敏感性分析显示Meta分析结果较为稳定。未发现发表偏倚。结论初乳喂养可提高早产儿唾液sIgA水平,但未发现其对尿sIgA和血IgA水平有影响。

Objective To systematically evaluate the effect of colostrum on immunoglobulin A(IgA)levels among prema⁃ture infants,so as to provide the evidence for improving premature infants'health with colostrum feeding.Methods Randomized controlled clinical trials(RCTs)or controlled clinical trials(CCTs)pertaining to the effect of colostrum and IgA levels among premature infants were retrieved in national and international databases from inception to September 30,2022,including CNKI,Wanfang Data,PubMed and Web of Science.Standardized mean difference(SMD)was used as an effect index for meta-analysis.The robustness of the results was evaluated using sensitivity analysis,and the pub⁃lication bias was evaluated using Begg's test,Egger's test and funnel plot.Results A total of 650 publications were re⁃trieved initially,and 10 studies were finally included,including 9 RCTs and one1 CCT,with 677 participants.Metaanalysis showed higher secretory salivary secretory IgA levels among premature infants with colostrum feeding than among controls(SMD=0.49,95%CI:0.08-0.89),and there were no significant differences between groups in terms of uri⁃nary secretory IgA levels(SMD=0.19,95%CI:-0.39-0.77)or blood IgA levels(SMD=0.29,95%CI:-0.01-0.59).Sensitiv⁃ity analysis showed robustness of meta-analysis results,and no publication bias was examined.Conclusion Colostrum feeding may increase salivary secretory IgA levels among premature infants;however,it has no effect on urine salivary secretory IgA levels or blood IgA levels.