摘要
背景临床工作中,常加用益生菌来治疗溃疡性结肠炎(ulcerative colitis,UC),但其在UC的治疗中到底发挥多大的作用、在哪一阶段起作用,目前尚无定论.目的采用Meta分析的方法比较益生菌与安慰剂在成人UC中的疗效及安全性.方法检索Pub Med, EMBASE, Cochrane Library,万方数据库,中国知网数据库中有关益生菌与安慰剂在UC治疗中的随机对照试验研究(randomized controlled trials,RCTs).结果 14项RCTs共计869例患者纳入本研究.其中,关于UC诱导缓解的研究有9项RCTs,关于维持治疗的有5项RCTs.比较其在UC诱导缓解中的作用,发现益生菌对比安慰剂的缓解率分别为45.5%、34.7%, RR=1.36,95%CI:1.11-1.66),二者有统计学意义(P=0.002),各研究之间不存在异质性(χ~2=11.81, P=0.16, I^2=32%);比较其在UC维持治疗中的作用,发现各研究间存在异质性(P=0.09, I^2=72%),进一步亚组分析发现,单独应用益生菌较单独应用安慰剂有效(P=0.004),而益生菌联合应用其他药物(5-ASA、美沙拉嗪、激素和硫唑嘌呤)与安慰剂联合其他药物相比,无统计学意义(P=0.95);比较益生菌与安慰剂在UC治疗中的安全性,发现二者副作用相近,分别为23.1%、15.3%,二者比较无统计学意义(P=0.86).结论在UC诱导缓解中,无论单独应用益生菌还是益生菌联合其他药物的作用比安慰剂效果好;在UC维持治疗中,单用益生菌的作用比安慰剂效果好,但合用其他药物时,益生菌无明显优势;二者在UC治疗中的安全性相近.
BACKGROUND In clinical work,probiotics are often used to treat ulcerative colitis(UC).However,it is unclear how and at which stage probiotics play a role in the treatment of UC.AIM To evaluate the efficacy and safety of probiotics vs placebo in the treatment of UC.METHODS PubMed,EMBASE,Cochrane Library,WanFang Database,and the Chinese Biomedical Database were searched.Data were extracted and selected using strict criteria.RESULTS Fourteen randomized controlled trials(RCTs)involving a total of 869 participants to investigate the effects of probiotics(n = 465)vs placebo(n = 404)on UC were included,of which nine evaluated the remission rate,and five estimated the recurrence rate.Compared with the placebo group,the remission rate of UC patients who received probiotics was significantly better(relative risk = 1.36;95%CI:1.11-1.66,P = 0.002).When comparing the recurrence rate of UC between the probiotics and placebo groups,it was found that there was a signi.cant heterogeneity(P = 0.09,I^2 = 72%).Subgroup analysis showed that probiotics alone were better than placebo(P = 0.004),while combined with others drugs,there was no signi.cant between the probiotics and placebo groups(P = 0.95).Four RCTs compared the safety,which showed that there was no signi.cant difference between the two groups(P = 0.86).CONCLUSION Probiotics have better effects in UC maintenance therapy than placebo.However,with regard to the recurrence rate of UC,probiotics alone have bene.ts in UC than placebo,while combined with other drugs,probiotics are not better than placebo.
作者
冯丽伟
赵岳
Li-Wei Feng;Yue Zhao(Department of ICU,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;College of Nursing,Tianjin Medical University,Tianjin 300070,China)
出处
《世界华人消化杂志》
CAS
2019年第6期367-375,共9页
World Chinese Journal of Digestology
