背景:多项研究质疑中性粒细胞减少饮食对减少癌症患者感染的益处,但是最近的调查显示,这种饮食仍然是处方。在这项研究中,我们试图评估中性粒细胞减少饮食在降低伴有中性粒细胞减少的癌症患者感染和死亡率方面的有效性.本综述是对先前发表的系统综述的更新。
方法:我们搜索了不同的数据库,以确定比较研究中性粒细胞减少症饮食与常规饮食对中性粒细胞减少症成人和癌症儿童的影响。我们使用Der-Simonian和Laird方法进行了随机效应荟萃分析,以汇集纳入研究的治疗效果。感兴趣的结果是死亡率,菌血症/真菌血症,主要感染,生活质量,以及中性粒细胞减少性发热和/或感染的复合结局。
结果:我们纳入了6项研究(5项随机分组),共1116例患者,772人(69.1%)接受了造血细胞移植。中性粒细胞减少饮食和常规饮食在主要感染率(相对风险[RR]1.16;95%CI0.94至1.42)或菌血症/真菌血症(RR0.96;95%CI0.60至1.53)之间没有统计学上的显着差异。在造血细胞移植患者中,中性粒细胞减少饮食与感染风险稍高相关(RR1.25;95%CI1.02~1.54).中性粒细胞减少饮食和常规饮食之间的死亡率没有差异(RR1.08,95%CI0.78至1.50)。
结论:目前没有证据支持在患有癌症的中性粒细胞减少患者中使用中性粒细胞减少饮食或其他食物限制。患者和临床医生应继续遵循美国食品和药物管理局建议的安全食品处理指南。
BACKGROUND: Multiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review.
METHODS: We searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random-effects meta-analyses using the Der-Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection.
RESULTS: We included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50).
CONCLUSIONS: There is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.