背景:这项研究的目的是研究精氨酸对结直肠癌(CRC)患者免疫功能和术后并发症的影响。
方法:我们进行了全面搜索,以在各种数据库中识别合格的RCT,比如PubMed,科克伦图书馆,EMBASE,WebofScience,MEDLINE,中国国家知识基础设施(CNKI),万方,VIP医药信息系统(VIP),和中国生物医学数据库(CBM)。本研究旨在检测IgA,IgG,和IgM水平以及CD4+和CD8+计数以及CD4+/CD8+比率。吻合口渗漏,停留时间(LOS)和手术部位感染(SSI)作为次要结局.Stata(StataCorp,版本14.0)用于数据分析。为了确保结果可靠,我们使用了元回归,敏感性分析,和发表偏倚分析。
结果:在检索到的681篇中,共有24篇出版物(包括1883例患者)符合纳入标准。精氨酸组显示出体液免疫的显著改善,IgA增加(SMD=0.45,95%CI:0.30-0.60),IgG(SMD=0.80,95%CI:0.64-0.96),和IgM(SMD=0.66,95%CI:0.39-0.93)。关于细胞免疫,与对照组相比,精氨酸组的CD4T细胞计数显着增加(SMD=1.03,95%CI:0.67-1.38)。然而,在相同的精氨酸组中,CD4/CD8比值显着降低(SMD=1.37,95%CI:0.88-1.86),表明这两种细胞类型之间平衡的变化。此外,与对照组相比,精氨酸组的CD8T细胞计数显着降低(SMD=-0.70,95%CI:-1.09至-0.32)。精氨酸组的吻合口漏也明显降低(SMD=-0.05,95%CI:-0.08至-0.02),SSIs发生率较低(RR=-0.02,95%CI:-0.05-0),患者住院时间较短(SMD=-0.15,95%CI:-0.38~-0.08).
结论:对CRC进行放射治疗后,精氨酸改善免疫功能并降低感染问题的风险。
背景:此荟萃分析的PROSPERO注册编号为CRD42024520509。
BACKGROUND: The aim of this study is to investigate the impact of arginine on immune function and postoperative complications in colorectal cancer (CRC) patients.
METHODS: We conducted a comprehensive search to identify eligible RCTs in various databases, such as PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang, VIP Medicine Information System (VIP), and Chinese Biomedical Database (CBM). This study aimed to examine IgA, IgG, and IgM levels as well as CD4+ and CD8+ counts as well as the CD4+/CD8+ ratio. Anastomotic leaking, length of stay (LOS), and surgical site infection (SSI) were included as secondary outcomes. Stata (StataCorp, version 14.0) was utilized for data analysis. To ensure the results were reliable, we used meta-regression, sensitivity analysis, and publication bias analysis.
RESULTS: A total of 24 publications (including 1883 patients) out of 681 that were retrieved fulfilled the inclusion criteria. The arginine group showed notable improvements in humoral immunity, with gains in IgA (SMD=0.45, 95% CI: 0.30-0.60), IgG (SMD=0.80, 95% CI: 0.64-0.96), and IgM (SMD=0.66, 95% CI: 0.39-0.93). With regards to cellular immunity, the arginine group exhibited a substantial increase in the CD4+ T cell count (SMD = 1.03, 95% CI: 0.67-1.38) compared to the control group. However, the CD4+/CD8+ ratio decreased significantly (SMD=1.37, 95% CI: 0.88-1.86) in the same arginine group, indicating a change in the balance between these two cell types. Additionally, the CD8+ T cell count showed a notable decrease (SMD=-0.70, 95% CI: -1.09 to -0.32) in the arginine group when compared to the control group. Anastomotic leakage was also considerably lower in the arginine group (SMD=-0.05, 95% CI: -0.08 to -0.02), the rate of SSIs was lower (RR = -0.02, 95% CI: -0.05-0), and the length of time patients spent in the hospital was shorter (SMD=-0.15, 95% CI: -0.38 to -0.08).
CONCLUSIONS: After radiation treatment for CRC, arginine improves immune function and decreases the risk of infection problems.
BACKGROUND: Registration with PROSPERO for this meta-analysis is number CRD42024520509.