目的 系统评价肠内免疫营养用于胃癌患者术后营养支持的近期疗效.方法 计算机检索Cochrane图书馆(2011年)、PubMed、EMBASE、CBM、CNKI、VIP、万方(截至2011年10月).收集肠内免疫营养用于胃癌术后营养支持的随机对照试验,采用Cochrane系统评价的方法,由2名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan5.0软件进行Meta分析.结果 共纳入17项随机对照试验,包括812例患者.Meta分析结果显示:在免疫功能方面CD3[加权均数差=5.81,95％可信区间(2.64,8.99)]、CD4[加权均数差=6.10,95％可信区间(4.39,7.81)]、IgG[加权均数差=1.33,95％可信区间(0.70,1.96)]、IgM[加权均数差=0.16,95％可信区间(0.06,0.26)]及胃癌患者术后体内白介素-2、白介素-6水平方面,肠内免疫营养与对照组差异均有统计学意义.结论 肠内免疫营养对胃癌患者术后免疫功能的改善有一定疗效且可控制胃癌患者术后的应激与炎性反应程度,提高患者术后近期疗效.但限于纳入研究在方法学方面的局限性,尚需要开展高质量的随机对照试验进一步验证其疗效.%Objective To evaluate the clinical efficacy and safty of postoperative enteral immunonutrition in patients undergoing surgery for gastric cancer. Methods We searched the electronic bibliographic databases, including the Cochrane Library, PubMed, EMBASE, CBM, CNKI, VIP database and Wanfang database to assemble the randomized controlled trials (RCTs) of postoperative enteral immunonutrition in patients undergoing surgery for gastric cancer. The deadline of the retrieval time was October 2011. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis on homogeneous studies. Results Seventeen RCTs involving 812 patients were included. The results of meta-analysis showed that there were significant differences in CD3 [WMD=5.81,95%CI(2.64,8.99) ] ,CD4[WMD=6.10,95%CI(4.39,7.81)], IgG [WMD = 1.33,95%CI(0.70,1.96)], IgM [WMD=0.16,95%CI(0.06,0.26)] and IL-2, IL-6 levels between the two groups of patients. Conclusion Enteral immunonutrition is effective to improve immunity, reduce stress and inflammatory reaction for postgastrectomy patients as compared with the control group. Limited to the study, more higher-quality RCTs are required to evaluate the effects.
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