家庭肠内营养在食管癌患者中有效性和安全性的 Meta 分析
he Efficacy and Safety of Home Enteral Nutrition in Patients with Esophageal Cancer： a Meta-analysis
背景 食管癌患者较常发生营养不良，国内外研究显示，营养不良严重影响患者的恢复。目前居家期间接受家庭肠内营养（HEN）的患者越来越多，但 HEN 对食管癌患者的有效性和安全性并不明确。目的 通过Meta 分析评价 HEN 对食管癌患者的有效性和安全性。方法 计算机检索 PubMed、Cochrane Library、Embase、Web of Science、CINAHL、Scopus、万方数据知识服务平台、中国知网、维普网及中国生物医学文献数据库，搜集有关食管癌患者接受 HEN 的随机对照试验，检索时限从建库至 2021 年 12 月。试验组患者接受 HEN 支持〔肠内管饲（ETF）和口服营养补充（ONS）均可〕，对照组仅接受常规口服饮食。由 2 名研究者独立筛选文献、提取资料，并采用Cochrane 协作网推荐的 RoB 2.0 工具对文献进行质量评价。采用 RevMan 5.4.1 软件进行 Meta 分析。结果 共纳入 14篇文献，包括 1 040 例食管癌患者。Meta 分析结果显示，试验组患者体质量（BW）增长值、体质指数（BMI）增长值、血红蛋白（HLB）增长值、血清总蛋白（TP）增长值、血清前白蛋白（PAB）增长值、血清转铁蛋白（TRF）增长值均高于对照组〔 SMD=0.63，95%CI（0.40，0.85）， P<0.000 01； SMD=0.60，95%CI（0.44，0.76）， P<0.000 01；SMD=1.58，95%CI（1.37，1.79）， P<0.000 01； SMD=1.19，95%CI（0.79，1.58）， P<0.000 01； SMD=0.97，95%CI（0.79，1.14）， P<0.000 01； SMD=1.12，95%CI（0.45，1.79）， P=0.001〕。在 ETF 亚组和 ONS 亚组中，试验组血清白蛋白（ALB）增长值均高于对照组〔 SMD=1.25，95%CI（0.82，1.68）， P<0.000 01； SMD=0.61，95%CI（0.26，0.97），P<0.000 01〕。试验组营养不良发生率低于对照组〔 OR=0.47，95%CI（0.33，0.67）， P<0.000 1〕。两组胃肠道并发症发生率比较，差异无统计学意义〔 RR=1.33，95%CI（1.00，1.77）， P=0.05〕。试验组和对照组生活质量评分比较，差异无统计学意义〔 MD=4.97，95%CI（0.06，9.87）， P=0.05〕；试验组躯体功能评分高于对照组〔 MD=6.67，95%CI（2.86，10.48）， P=0.000 6〕，疲劳症状评分低于对照组〔 MD=-7.31，95%CI（-11.85，-2.77）， P=0.002〕。敏感性分析结果显示，合并结果稳定可靠。结论 HEN 能够改善食管癌术后出院患者的营养状况和躯体功能，并减轻患者的疲劳症状，且并未增加胃肠道并发症的发生率，但暂未发现能够改善患者总体生活质量。
Background Malnutrition is a common complication in patients with esophageal cancerwhich has been validated by domestic and international studies to seriously impact the recovery of patients. While the number of patients receiving home enteral nutritionHENis increasingthe effectiveness and safety of HEN for patients with esophageal cancer remains unclear. Objective To systematically evaluate the effectiveness and safety of HEN by meta-analysis. Methods RCTs on the HEN in patients with esophageal cancer were retrieved in PubMedCochrane LibraryEmbaseWeb of ScienceCINAHL ScopusWanfang Data Knowledge Service PlatformCNKIVIP and CBM from inception to December 2021.Patients in the experimental group received HEN supportboth enteral tube feedingETF and oral nutritional supplementONS were both acceptablewhile patients in the control group received conventional oral diet only. Two researchers independently screened the literature and extracted data. The RoB 2.0 recommended by the Cochrane Collaboration was used to evaluate the quality of the included studiesand the RevMan 5.4.1 software was used to perform the meta-analysis. ResultsA total of 14 articles were includedinvolving 1 040 patients with esophageal cancer. Meta-analysis showed that the increase values of body massBWbody mass indexBMIhemoglobinHLBserum total proteinTPserum prealbuminPAB and serum transferrinTRF in the experimental group were higher than those in the control group SMD=0.6395%CI0.400.85 P<0.000 01SMD=0.6095%CI0.440.76 P<0.000 01 SMD=1.5895%CI1.371.79 P<0.000 01 SMD=1.1995%CI0.791.58 P<0.000 01 SMD=0.9795%CI0.791.14 P<0.000 01 SMD=1.1295%CI0.451.79P=0.001. The increase value of serum albuminALB in the experimental group was higher than that in the control group in both ETF and ONS subgroups SMD=1.2595%CI0.821.68 P<0.000 01 SMD=0.6195%CI0.260.97P<0.000 01. The incidence of malnutrition was lower in the experimental group than in the control group OR=0.4795%CI0.330.67 P<0.000 1. There was no statistically significant differences in the incidence of gastrointestinal complications RR=1.3395%CI1.001.77 P=0.05and life quality score MD=4.9795%CI0.069.87 P=0.05 between the two groups. The physical function score of the experimental group was higher than that of the control group MD=6.6795%CI 2.8610.48 P=0.000 6and the fatigue symptom score was lower than that of the control group MD=-7.3195%CI-11.85-2.77 P=0.002. Sensitivity analysis showed that the combined results were stable and reliable. Conclusion HEN can significantly improve the nutritional status and physical functionreduce fatigue symptoms of discharged patients after esophageal cancer surgeryand does not increase the incidence of gastrointestinal complicationshoweverit has not been found to improve the global overall quality of life.
薛珊 1，李来有 1*，梁军利 1，靳英辉 2，魏淑艳 3
10.12114/j.issn.1007-9572.2022.0853
肿瘤学临床医学医学研究方法
肠道营养食管肿瘤家庭肠内营养管饲喂养口服营养补充营养状况生活质量随机对照试验Meta 分析
薛珊 1，李来有 1*，梁军利 1，靳英辉 2，魏淑艳 3.家庭肠内营养在食管癌患者中有效性和安全性的 Meta 分析[EB/OL].(2023-04-03)[2025-07-09].https://chinaxiv.org/abs/202304.00914.点此复制
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