鱼油脂肪乳与大豆油脂肪乳对早产儿及极低出生体重儿神经发育影响的Meta分析

Meta-analysis on the effects of fish oil-based versus soybean oil-based lipid emulsions on neurodevelopment in preterm and very low birth weight infants

摘要

目的 比较鱼油脂肪乳与大豆油脂肪乳对早产儿和/或极低出生体重儿头围生长及脑部磁共振成像(MRI)指标的影响,为临床实践提供循证参考依据。方法 系统检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方医学网等数据库自建库至2025年5月收录的相关随机对照试验(RCT)和队列研究。由2名研究者独立筛选文献、提取数据并评价研究质量,采用RevMan 5.3软件进行Meta分析。结果 共纳入9项研究(4项RCT、5项队列研究),累计样本量为1 451例。2项MRI研究的Meta分析显示,与大豆油脂肪乳组相比,鱼油脂肪乳组的大脑总体积(MD=24.61 cm³,95%CI:6.19~43.02,P=0.009)和脑干体积(MD=0.70 cm³,95%CI:0.34~1.06,P<0.001)较大;两组小脑体积差异无统计学意义(P＞0.05)。8项研究的合并结果显示,两组头围Z评分(HCZ)差异无统计学意义(P＞0.05)。结论 与大豆油脂肪乳相比,鱼油脂肪乳未显著改善早产儿和/或极低出生体重儿的HCZ;有限的MRI证据提示其可能与较大的大脑总体积和脑干体积相关。鉴于MRI分析仅纳入2项研究、样本量有限且对照制剂存在异质性,仍需更大样本的高质量、同质性研究验证。

Abstract

Objective To compare the effects of fish oil-based versus soybean oil-based lipid emulsions on head circumference growth and brain magnetic resonance imaging (MRI) measures in preterm and/or very low birth weight infants, so as to provide evidence for clinical practice. Methods Relevant randomized controlled trials (RCTs) and cohort studies published from database inception to May 2025 were retrieved through PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data. Two reviewers independently screened the literature, extracted data, and assessed study quality. Meta-analyses were performed using RevMan 5.3. Results Nine studies (4 RCTs and 5 cohort studies) were included, involving a total of 1 451 infants. The meta-analysis of two MRI studies showed that, compared with the soybean oil-based lipid emulsion group, the fish oil-containing lipid emulsion group had greater total brain volume (MD=24.61cm³, 95%CI: 6.19-43.02, P=0.009) and brainstem volume (MD=0.70cm³, 95%CI: 0.34-1.06, P<0.001). No statistically significant between-group difference was observed in cerebellar volume (P>0.05). The pooled results of eight studies showed no statistically significant difference in head circumference Z score (HCZ) between the two groups (P>0.05). Conclusions Compared with soybean oil-based lipid emulsions, fish oil-containing lipid emulsions did not significantly improve HCZ in preterm and/or very-low-birth-weight infants. Limited MRI evidence suggested that their use might be associated with greater total brain and brainstem volumes. Given that the MRI analyses included only two studies, with limited sample sizes and heterogeneous comparator formulations, these findings require confirmation in larger, high-quality studies with more homogeneous comparator formulations.

关键词

早产儿 / 极低出生体重儿 / 鱼油脂肪乳 / 大豆油脂肪乳 / 神经发育 / Meta分析

Key words

preterm infants / very low birth weight infant / fish oil-containing lipid emulsion / soybean oil-based lipid emulsion / neurodevelopment / meta-analysis

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基金资助

中国医药教育协会《医院高质量发展与药学创新研究》专项课题(2024-PJZXKT-08)