Department of Medical Laboratory, The People's Hospital of Leshan, Leshan, China.
Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Ann Palliat Med. 2021 Nov;10(11):11615-11627. doi: 10.21037/apm-21-2669.
Precision hepatectomy for primary liver cancer has been widely used in clinical practice. As an effective nutritional supplement to prevent endotoxemia and hepatic impairment, microecological agents have been used together with traditional enteral nutritional support substances in several clinical studies.
Chinese and English databases were searched using the terms "hepatocellular carcinoma", "hepatectomy", "microecological agents", and "microecological regulators". The search terms were "hepatocellular carcinoma", "liver resection", "microecological agents", and "microecological regulators". Meta-analysis was performed using Rev Man 5.3 and Stata 13 software provided by the Cochrane system.
Eleven randomized controlled trials (RCTs) were included in this study. Of these, all 11 described the correct method of random assignment; 8 described in detail the concealment of the assignment scheme; and 9 used blinding methods in the research. Microecological agents significantly reduced total bilirubin (TBIL) levels [mean difference (MD)=-0.10, 95% confidence interval (CI): (-0.14, -0.06), P<0.00001] of patients after hepatectomy. The alanine transaminase (ALT) levels [MD =-3.65, 95% CI: (-14.65, 7.34), P=0.52], aspartate aminotransferase (AST) levels [MD =-0.64, 95% CI: (-6.87, 5.58), P=0.84], prothrombin level [MD=1, 95% CI: (-2.57, 4.57), P=0.58], and C-reactive protein (CRP) level [MD =-0.28, 95% CI: (-3.01, 2.45), P=0.84] among the included articles were statistically significant. However, probiotics could significantly reduce the risk of postoperative infection in patients with liver cancer (MD =0.23, 95% CI: (0.07, 0.79), P=0.02 <0.05), and did not significantly increase the risk of complications in patients with liver cancer [odds ratio (OR) =0.82, 95% CI: (0.38, 1.77), P=0.61].
This study used meta-analysis to confirm that microecological agents can significantly improve the immune function of patients with hepatocellular carcinoma, and have alleviating effects on endotoxemia and hyperbilirubinemia.
原发性肝癌的精准肝切除术已在临床实践中广泛应用。微生态制剂作为预防内毒素血症和肝损伤的有效营养补充剂，在几项临床研究中已与传统肠内营养支持物质联合使用。
使用“肝细胞癌”“肝切除术”“微生态制剂”和“微生态调节剂”等术语在中国和英文数据库中进行检索。采用 RevMan 5.3 和 Cochrane 系统提供的 Stata 13 软件进行 Meta 分析。
本研究共纳入 11 项随机对照试验（RCT）。其中，所有 11 项研究均正确描述了随机分组方法；8 项研究详细描述了分配方案的隐藏；9 项研究在研究中使用了盲法。微生态制剂可显著降低肝切除术后患者的总胆红素（TBIL）水平[均数差（MD）=-0.10，95%置信区间（CI）：（-0.14，-0.06），P<0.00001]。微生态制剂对丙氨酸氨基转移酶（ALT）水平[MD=-3.65，95%CI：（-14.65，7.34），P=0.52]、天门冬氨酸氨基转移酶（AST）水平[MD=-0.64，95%CI：（-6.87，5.58），P=0.84]、凝血酶原水平[MD=1，95%CI：（-2.57，4.57），P=0.58]和 C 反应蛋白（CRP）水平[MD=-0.28，95%CI：（-3.01，2.45），P=0.84]的影响无统计学意义。然而，益生菌可显著降低肝癌患者术后感染的风险（MD=0.23，95%CI：（0.07，0.79），P=0.02<0.05），且不会显著增加肝癌患者的并发症风险[比值比（OR）=0.82，95%CI：（0.38，1.77），P=0.61]。
本研究采用 Meta 分析证实，微生态制剂可显著改善肝癌患者的免疫功能，对内毒素血症和高胆红素血症有缓解作用。
