微生态制剂治疗肠易激综合征的临床循证

Probiotic Agents for Treatment of Irritable Bowel Syndrome: A Systematic Review

目的：系统评价微生态制剂对肠易激综合征的疗效。方法：检索PubMed、EMBASE、TheCochrane Central Register of Controlled Trials、中国生物医学文献数据库，对纳入文献进行质量评定，提取研究所需数据作系统评价。结果：检索到491篇文献，有13个双盲随机对照研究符合要求，共943例患者纳入分析，定性系统评价示微生态制剂不良反应少，能改善总体症状、腹痛、腹胀，但对大便性状和频率效果不明显，短期服用对生活质量评分无改善。对能提取数据的试验作荟萃分析，提示微生态制剂对肠易激综合征总体疗效优于安慰剂[相对危险度（RR）=2．00，95％可信区间（CI）：1．18～3．38，P〈0．05）]，能有效改善腹痛[标准化均差（SMD）=-1．62，95％CI：-2．26～0．98，P〈0．01]，腹胀（SMD=-1．54，95％CI：-2．20～0．88，P〈0．01）和胃肠胀气（SMD-2．34，95％CI：-3．47～1．21，P〈0．01）等症状。结论：微生态制剂是治疗肠易激综合征安全有效的药物，有助于改善总体症状，尤其是腹痛、腹胀等方面疗效明显。

Objective： To systematically assess the effects of probiotic agents for the treatment of irritable bowel syndrome （IBS）. Methods： Systematic review of all eligible trials was performed by searching PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Chinese Biomedical Literature Database. The resulting papers were evaluated for quality of study before inclusion. Data were retrieved from included studies for systemic review. Results： Of 491 studies, only 13 controlled, double-blind, randomized trials including 943 patients were selected. The quality of studies was assessed using Jadad＇s Score Scale. Systemic analyses showed that probiotic agents were safe and effective in the improvement of global symptoms, alleviation of bloating and reduction of abdominal pain or discomfort. However, there was no significant improvement in defecation and no increase in the quality of life. Only parts of trials provided enough data for meta-analysis. Compared with placebo treatment, probiotic agents showed significant positive effects in the global symptoms assessment （RR=2.00,95 % CI ： 1.18 to 3.38, P〈0.05 ）, abdominal pain relief（SMD=- 1.62,95 % CI： -2.26 to 0.98, P〈0.01 ）, bloating alleviation （SMD=- 1.54,95 % CI ： -2.20 to 0.88, P〈0.01 ） and flatulence reduction （ SMD=-2.34,95 % CI ： -3.47 to 1.21 ,P〈0.01 ）. Conclusion： Probiotic agents are effective and safe for the treatment of IBS, especially in improving global symptoms, alleviating abdominal pain, reducing bloating and flatulence.