Abstract:
Objective To explore the effects of arginine-enhanced immunonutritional support on postoperative immune function and incidence of infected complications in patients with gastric cancer.
Methods PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang database, VIP database and other databases were retrieved to collect all the randomized controlled trials(RCTs) published from 1996 to January 2017, of which researched arginine-enhanced immunonutrition applied in patients with gastric cancer who need postoperative nutritional support. And relevant theses, meeting abstracts and other gray literature publications were searched through the internet. We conducted the quality assessment of included literatures with Cochrane Library’s risk of bias table and the modified Jadad Scale by two independent reviewers. The RevMan 5.2 software was used for meta-analysis on homogeneous studies.Results A total of 241 literatures were retrieved, however, only 13 articles were included in this study, involving 947 cases. Meta analysis results illustrated that perioperative using of arginine-enhanced immune nutrition could reduce the rate of postoperative infection in patients with gastric cancer OR(odds ratio)=0.42,95%CI (confidence interval)0.21~0.86,P=0.02, and the difference was statistically significant. Cellular immune function was enhanced simultaneously. CD3 + T cell subsetsMD(mean difference) 4.95,95%CI 3.82~6.08,P<0.000 01, CD4
+T cell subsets (MD 5.38,95%CI 3.02~7.74,P<0.000 01), CD8
+ T cell subsets (MD -1.46,95%CI -2.53~-0.39,P=0.008)、CD4
+/CD8
+(MD 0.26,95%CI 0.02~0.50,P=0.03), and the indicators reflect humoral immune function (IgA, IgG, IgM, etc.) in the experimental group were significantly higher than those in the control group, all the differences between the two groups were statistically significant.
Conclusion Arginine-enhanced immunonutrition can enhance postoperative immune function in patients with gastric cancer and reduce the incidence of postoperative infectious complications.