个体化营养支持对鼻咽癌放化疗患者营养状况影响的Meta分析
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摘要
目的系统评价个体化营养支持对鼻咽癌同期放化疗患者营养相关指标的影响。方法计算机检索中国知网、万方、维普、Cochrane Library、web of science、pubmed数据库,收集从建库起至2018年3月国内外发表的关于个体化营养支持对鼻咽癌同期放化疗患者营养相关指标影响且符合纳排标准的相关原始研究。应用stata12.0软件进行数据分析,采用I2检验评估各研究结果间的异质性,漏斗图定性评估发表偏倚。结果共纳入符合纳排标准的9篇随机对照研究,总样本量727例,实验组(个体化营养干预)361例,对照组(常规饮食)366例。结果显示,个体化营养治疗的总白蛋白[SMD=1.12, 95%CI(0.85, 1.39),P<0.001]、血红蛋白[SMD=0.81, 95%CI(0.59, 1.03), P<0.001]、白蛋白[SMD=0.61,95%CI(0.37, 0.85), P<0.001]、体重[SMD=0.67, 95%CI(0.47,0.86), P<0.001]、体重指数[OR=0.20, 95%CI(0.11, 0.35), P<0.001]均明显高于对照组。结论与常规饮食相比,个体化营养支持能有效改善鼻咽癌同步放化疗患者营养状况,进而减少患者营养不良发生率,从而提高患者的生活质量、治疗耐受力及疗效。
Objective To systematically evaluate the effects of individualized nutritional support on nutritional related indicators in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy. Methods The database of CNKI, Wanfang, VIP, Cochrane Library, web of science and PubMed were retrieved, relevant original studies published at home and abroad from the establishment of the database to March 2018 on the effect of individualized nutrition support on nutrition-related indicators of patients with concurrent radiotherapy and chemotherapy of nasopharyngeal cancer and meeting the exclusion criteria were collectedData were analyzed by Stata 12.0 software, and heterogeneity was assessed by I2 test.Funnel plot was used to qualitatively evaluate publication bias. Results A total of 9 randomized controlled studies were included, with a total of 727 cases, 361 cases in the experimental group(individual nutrition intervention) and 366 cases in the control group(conventional diet). The results showed that the total albumin [SMD=1.12, 95% CI(0.85,1.39), P<0.001],hemoglobin [SMD=0.81, 95%CI(0.59, 1.03), P<0.001], albumin [SMD=0.61, 95%CI(0.37, 0.85), P<0.001], weight [SMD=0.67,95%CI(0.47,0.86), P<0.001], body mass index [OR=0.20, 95%CI(0.11, 0.35), P<0.001] were all significantly higher than those in the control group and the differences were statistically significant. Conclusion Compared with conventional diet, individualized nutritional support can effectively improve the nutritional status of patients with nasopharyngeal carcinoma and reduce the incidence of dystrophy, and improve the patient's quality of life, treatment tolerance and curative effect.
Objective To systematically evaluate the effects of individualized nutritional support on nutritional related indicators in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy. Methods The database of CNKI, Wanfang, VIP, Cochrane Library, web of science and PubMed were retrieved, relevant original studies published at home and abroad from the establishment of the database to March 2018 on the effect of individualized nutrition support on nutrition-related indicators of patients with concurrent radiotherapy and chemotherapy of nasopharyngeal cancer and meeting the exclusion criteria were collectedData were analyzed by Stata 12.0 software, and heterogeneity was assessed by I2 test.Funnel plot was used to qualitatively evaluate publication bias. Results A total of 9 randomized controlled studies were included, with a total of 727 cases, 361 cases in the experimental group(individual nutrition intervention) and 366 cases in the control group(conventional diet). The results showed that the total albumin [SMD=1.12, 95% CI(0.85,1.39), P<0.001],hemoglobin [SMD=0.81, 95%CI(0.59, 1.03), P<0.001], albumin [SMD=0.61, 95%CI(0.37, 0.85), P<0.001], weight [SMD=0.67,95%CI(0.47,0.86), P<0.001], body mass index [OR=0.20, 95%CI(0.11, 0.35), P<0.001] were all significantly higher than those in the control group and the differences were statistically significant. Conclusion Compared with conventional diet, individualized nutritional support can effectively improve the nutritional status of patients with nasopharyngeal carcinoma and reduce the incidence of dystrophy, and improve the patient's quality of life, treatment tolerance and curative effect.
引文
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[13]潘冬梅,廖金莲,韦榕飒,等.鼻咽癌同期放化疗患者个体化营养支持的应用效果观察[J].广西医学,2015,37(12):1848-1850.
[14]韩忠秀,唐忠敏,周小梅,等.饮食干预对鼻咽癌同期放化疗患者营养状况的影响[J].蛇志,2016,28(1):57-58.
[15]许丽云.个体化营养干预对鼻咽癌同步放化疗患者的影响[J].当代护士(上旬刊),2017,(10):77-79.
[16]邓丹华.口服营养补充对鼻咽癌放化疗患者作用的临床研究[J].中国实用医药,2017,12(4):177-179.
[17]潘宇,吴伦清,刘翠容,等.添加精氨酸的个体化营养支持对同步放化疗鼻咽癌营养不良患者的影响[J].中国临床新医学,2017,10(5):417-420.
[18]薛楠.动态营养干预对放化疗鼻咽癌患者近期临床结局的影响[J].中国保健营养,2017,27(18):49-50.
[19]曾宪涛,包翠萍,曹世义,等.Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,4(3):183-185.
[20]蔡晓娟,陆雁,张兰凤,等.个体化系统营养干预在食管癌放疗病人护理中的应用效果观察[J].护理研究,2017,31(13):1629-1631.
[21]张小平,王少新,杨登权,等.喉癌患者营养风险筛查及个体化营养干预的效果评价[J].中国食物与营养,2018,24(3):74-77.
[22]崔巍,韩磊.鼻咽癌患者同步放化疗期间营养状况变化及其营养支持治疗的影响[J].中华肿瘤防治杂志,2011,18(18):1466-1469.
[2] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J].CA-A Cancer Journal for Clinicians, 2015, 65(2):87-108.
[3] Bossola M.Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy:a narrative review[J]. Nutrients,2015, 7(1):265-276.
[4]刘洁,廖剑询,杨巧.晚期鼻咽癌同步放化疗患者营养状况监测及院内感染分析[J].临床耳鼻咽喉头颈外科杂志,2014,28(3):188-191.
[5]于康,周晓容,郭亚芳.恶性肿瘤住院患者营养风险和营养不足发生率及营养支持应用状况调查[J].肿瘤学杂志,2011,17(6):408-411.
[6]韦燕.鼻咽癌患者的营养状况及营养干预[J].医学综述,2013,19(10):1771-1773.
[7]潘海卿,王笑微,丁进,等.早期营养干预对头颈部肿瘤同期放化疗患者营养状况及耐受性的影响[J].中国现代医生,2014,52(22):154-157.
[8]郭明娟,杨丽.鼻咽癌放化疗后营养不良病人的生活质量及护理研究进展[J].护理研究,2017,31(4):385-388.
[9] Nitenberg G, Raynard B. Nutritional support of the cancer patient:issues and dilemmas[J]. Critical Reviews in Oncology Hematology,2000, 34(3):137-168.
[10]方仕,林忠,商谊,等.复方要素膳对鼻咽癌放化疗患者治疗的辅助作用[J].广州中医药大学学报,1998,15(3):25-28.
[11]余意.系统营养干预对鼻咽癌治疗的影响[D].广州:南方医科大学,2009.
[12]张娟,徐海声.营养干预对鼻咽癌患者放化疗疗效的影响[J].实用癌症杂志,2014,29(2):149-151.
[13]潘冬梅,廖金莲,韦榕飒,等.鼻咽癌同期放化疗患者个体化营养支持的应用效果观察[J].广西医学,2015,37(12):1848-1850.
[14]韩忠秀,唐忠敏,周小梅,等.饮食干预对鼻咽癌同期放化疗患者营养状况的影响[J].蛇志,2016,28(1):57-58.
[15]许丽云.个体化营养干预对鼻咽癌同步放化疗患者的影响[J].当代护士(上旬刊),2017,(10):77-79.
[16]邓丹华.口服营养补充对鼻咽癌放化疗患者作用的临床研究[J].中国实用医药,2017,12(4):177-179.
[17]潘宇,吴伦清,刘翠容,等.添加精氨酸的个体化营养支持对同步放化疗鼻咽癌营养不良患者的影响[J].中国临床新医学,2017,10(5):417-420.
[18]薛楠.动态营养干预对放化疗鼻咽癌患者近期临床结局的影响[J].中国保健营养,2017,27(18):49-50.
[19]曾宪涛,包翠萍,曹世义,等.Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,4(3):183-185.
[20]蔡晓娟,陆雁,张兰凤,等.个体化系统营养干预在食管癌放疗病人护理中的应用效果观察[J].护理研究,2017,31(13):1629-1631.
[21]张小平,王少新,杨登权,等.喉癌患者营养风险筛查及个体化营养干预的效果评价[J].中国食物与营养,2018,24(3):74-77.
[22]崔巍,韩磊.鼻咽癌患者同步放化疗期间营养状况变化及其营养支持治疗的影响[J].中华肿瘤防治杂志,2011,18(18):1466-1469.