Department of general surgery, Qionghai People's Hospital, Hainan, China.
Int Wound J. 2022 Nov;19(7):1625-1636. doi: 10.1111/iwj.13763. Epub 2022 Mar 29.
We performed a meta-analysis to evaluate the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. A systematic literature search up to November 2021 was done, and 10 studies included 1056 subjects with gastric cancer undergoing a total gastrectomy at the start of the study: 505 of them were provided with enteral immunonutrition, and 551 were enteral nutrition. They were reporting relationships about the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of enteral immunonutrition compared with enteral nutrition on surgical wound infection, immune and inflammatory factors, serum proteins, and cellular immunity in subjects with gastric cancer undergoing a total gastrectomy using the dichotomous or contentious method with a random or fixed-effect model. Enteral immunonutrition had no significant difference in the surgical wound infection (OR, 0.77; 95% CI, 0.50-1.19, P = .24), the infectious complication (OR, 0.72; 95% CI, .48-1.09, P = .13), the systemic inflammatory response syndrome (MD, -0.50; 95% CI, -1.40 to 0.39, P = .27), the CD8+ level (MD, 1.34; 95% CI, 0-2.68, P = .05), the CD4+ level (MD, 1.21; 95% CI, -7.65 to 10.07, P = .79), the CD4-CD8+ (MD, 0.55; 95% CI, 0-1.10, P = .05), the lymphocyte (MD, -0.77; 95% CI, -1.87 to 0.33, P = .17), and the transferrin (MD, 0.03; 95% CI, -0.01 to 0.08, P = .14) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. However, enteral immunonutrition had significantly higher proalbumin (MD, 22.15; 95% CI, 3.57-40.72, P = .02), IgM (MD, 0.47; 95% CI, 0.43-0.50, P < .001), and IgG (MD, 1.98; 95% CI, 1.08-2.89, P < .001) compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Enteral immunonutrition had no significant difference in the surgical wound infection, the infectious complication, the systemic inflammatory response syndrome, the CD8+ level, the CD4+ level, the CD4+/CD8+, the lymphocyte, and the transferrin, and had significantly higher proalbumin, IgM, and IgG compared with enteral nutrition in subjects with gastric cancer undergoing a total gastrectomy. Further studies are required to validate these findings or to affect the confidence level.
我们进行了一项荟萃分析，以评估与肠内营养相比，肠内免疫营养对接受全胃切除术的胃癌患者手术部位感染、免疫和炎症因子、血清蛋白和细胞免疫的影响。系统检索截至 2021 年 11 月，并纳入了 10 项研究，共纳入 1056 例接受全胃切除术的胃癌患者：其中 505 例接受肠内免疫营养，551 例接受肠内营养。它们报告了关于肠内免疫营养与肠内营养相比对接受全胃切除术的胃癌患者手术部位感染、免疫和炎症因子、血清蛋白和细胞免疫的影响的关系。我们使用二分类或连续变量方法，以随机或固定效应模型计算比值比（OR）或均数差（MD）及其 95%置信区间（CI），以评估与肠内营养相比，肠内免疫营养对接受全胃切除术的胃癌患者手术部位感染、免疫和炎症因子、血清蛋白和细胞免疫的影响。肠内免疫营养在手术部位感染（OR，0.77；95%CI，0.50-1.19，P=0.24）、感染性并发症（OR，0.72；95%CI，0.48-1.09，P=0.13）、全身炎症反应综合征（MD，-0.50；95%CI，-1.40 至 0.39，P=0.27）、CD8+水平（MD，1.34；95%CI，0-2.68，P=0.05）、CD4+水平（MD，1.21；95%CI，-7.65 至 10.07，P=0.79）、CD4-CD8+（MD，0.55；95%CI，0-1.10，P=0.05）、淋巴细胞（MD，-0.77；95%CI，-1.87 至 0.33，P=0.17）和转铁蛋白（MD，0.03；95%CI，-0.01 至 0.08，P=0.14）方面与肠内营养相比没有显著差异。然而，与肠内营养相比，肠内免疫营养显著提高了前白蛋白（MD，22.15；95%CI，3.57-40.72，P=0.02）、IgM（MD，0.47；95%CI，0.43-0.50，P<0.001）和 IgG（MD，1.98；95%CI，1.08-2.89，P<0.001）。肠内免疫营养在手术部位感染、感染性并发症、全身炎症反应综合征、CD8+水平、CD4+水平、CD4+/CD8+、淋巴细胞和转铁蛋白方面与肠内营养相比没有显著差异，而在前白蛋白、IgM 和 IgG 方面显著高于肠内营养。需要进一步的研究来验证这些发现或影响置信水平。
