微生态制剂治疗肝硬化的Meta分析

Clinical effect of probiotics in treatment of liver cirrhosis: a Meta-analysis

目的系统评价微生态制剂治疗肝硬化的有效性。方法计算机检索PubMed、Embase、Cochrane Library以及中国期刊全文数据库、维普、万方数据库,全面收集关于微生态制剂治疗肝硬化的随机对照试验,筛选后的文献应用Rev Man5.3软件进行Meta分析,其中二分类变量采用率差(RD)及其95%可信区间(95%CI)作为效应量;连续性变量若测量单位一致则采用加权均数差(WMD),测量单位不一致采用标准化均数差(SMD)及其95%CI进行评估。发表偏倚采用漏斗图进行分析。结果纳入符合标准的文献18篇,共1411例肝硬化患者,其中治疗组726例,对照组685例。与对照组相比,微生态制剂治疗可显著提高临床总体有效率(RD=0.28,95%CI:0.22~0.34,P<0.001);亦可以明显改善肝功能生化指标:ALT(SMD=-0.90,95%CI:-1.14^-0.66,P<0.001)、TBil(WMD=-15.99,95%CI:-26.42^-5.57,P<0.001)、Alb(SMD=0.66,95%CI:0.40~0.93,P<0.001),降低内毒素(SMD=-1.13,95%CI:-2.11^-0.15,P<0.001)及血氨水平(WMD=-15.86,95%CI:-21.54^-10.18,P<0.001)。结论微生态制剂可明显改善肝硬化患者的肝功能,有效抑制肝硬化进展,降低肝性脑病等并发症的发生风险,提高临床总有效率,且耐受性较好。

Objective To investigate the clinical effect of probiotics in the treatment of liver cirrhosis through a systematic review.Methods PubMed,Embase,Cochrane Library,Chinese Scientific Journal Full-Text Database,VIP,and Wanfang Data were searched for randomized controlled trials(RCTs)of probiotics for the treatment of liver cirrhosis.RevMan 5.3 software was used for the meta-analysis of the articles screened out.Rate difference(RD)and its 95%confidence interval(95%CI)were used as effect size indicators for binary variables;weighted mean difference(WMD)was used for evaluating continuous variables with the same unit,and standardized mean difference(SMD)and its 95%CI were used for evaluating continuous variables with different units.Funnel plots were used to analyze publication bias.Results A total of 15 RCTs which met the inclusion criteria were included,and there were 1411 patients with liver cirrhosis in total(726 in treatment group and 685 in control group).Compared with the control group,the treatment group had significant improvements in overall response rate(RD=0.28,95%CI:0.22-0.34,P<0.001)and biochemical parameters for liver function including alanine aminotransferase(SMD=-0.90,95%CI:-1.14 to-0.66,P<0.001),total bilirubin(WMD=-15.99,95%CI:-26.42 to-5.57,P<0.001),albumin(SMD=0.66,95%CI:0.40-0.93,P<0.001),endotoxin(SMD=-1.13,95%CI:-2.11 to-0.15,P<0.001),and blood ammonia(WMD=-15.86,95%CI:-21.54 to-10.18,P<0.001).Conclusion Probiotics can significantly improve liver function in patients with liver cirrhosis,effectively inhibit the progression of liver cirrhosis,reduce the risk of complications including hepatic encephalopathy,and increase overall response rate and have good tolerability.