核酸及核苷酸用于营养及免疫调节治疗的早期卫生技术评估

目的 评价核酸或核苷酸用于临床营养支持和免疫调节治疗的安全性、有效性和经济学价值。方法 检索中国生物医学文献数据库、Cochrane图书馆、MEDLINE光盘数据库、EMBASE光盘数据库,并联机检索SCI数据库,鉴定有关随机对照试验(RCTs),采用RevMan4.l进行Meta-分析。结果 纳入46个随机对照试验,涉及核酸/核苷酸用于肠内营养支持、婴儿营养、免疫调节治疗。18个研究报告了含核苷酸组分的免疫增强型肠内营养对外科术后和危重症患者预后的影响,合并分析发现免疫营养对患者感染率、住院时间和费用有肯定意义。发现1个报告在母乳代用品中加入核苷酸对婴儿免疫功能影响的研究,但报告对临床结局无明显影响。27个对“免疫核酸”用于免疫调节治疗的随机对照试验均为低质量研究,合并分析无法肯定iRNA的临床价值。结论 在外科术后患者应用免疫肠内营养制剂可降低感染率、缩短住院时间并可能减少住院费用,但不能确定作为组分之一的核苷酸的作用。尚无证据支持在母乳代用品中添加核苷酸具有临床意义。不能肯定免疫核酸是否具有免疫调节作用,亦未发现核酸在延缓衰老、改善老年人健康状况方面的可用证据。建议对核酸、核苷酸用于营养支持治疗和免疫调节治疗进行进一步研究,严格规范“核酸营养品”的宣传和应用。

Nucleic acid and nucleotides for nutritional support and immune regulation therapy: earlier health technology assessment

Objective To evaluate the efficacy, safety and economical values of nucleic acid/nucleotides for clinical nutritional support and immune treatment. Methods The following electronic databases were searched: Chinese Biomedicine database(CBM), MEDLINE,EMBASE and SCI. Data were extracted by two reviewers. Applied RevMan 4.1 for statistical analyse Results Forty - six randomized control trials were identified, involving nucleic acids/nucleotides for clinical nutritional support, infant feed, immune treatment. Eighteen randomized trials comparing the use of immunonutrition which comprises nucleotides with standard enteral nutrition in surgical and critical ill patients. Combined analysis directed that immunonutrition therapy decrease infection events, length of hospitalization and the cost. Only one trial reported the effects of adding nucleotides to breast milk substitute, but there is no valuable results for clinical practice. Twenty- seven low quality trials compared the use of "immune RNA(iRNA)" with standard methods in hepatitis, carcinoma and burn patients, combined analysis directed that there are not valid evidences to confirm the value of iRNA. Conclusions Immunonutrition may decrease infection rates, length of hospitalisation and cost in surgery and critical ill patients, but we can not affirm the role of the nucleotides in immunonutrition. No evidences support the point of adding nucleotides in breast milk substitute. Also, we can not affirm the role of iRNA in clinical immune regulation treatment. There are no available evidences in nucleic acids for caducity prevention and improvement of aging people's health.Consequently, we advice Chinese health officials to enhance the management for applying "nucleic acids nutrients".