益生菌对溃疡性结肠炎诱导缓解及维持治疗疗效的Meta分析

Effect of probiotic preparations on inducing and mainfaining remission of ulcerative colitis:a meta-analysis

目的评价益生菌对溃疡性结肠炎(UC)诱导缓解及维持治疗的疗效。方法检索PubMed、EMBASE、Web of Science、The Cochrane Central Register of Controlled Trials等外文数据库(1966-2009年8月)及中国期刊全文数据库、中国科技期刊数据库(维普)、万方数字化期刊全文数据库等中文数据库(1979-2009年8月)中有关益生菌对UC诱导缓解及维持治疗的临床随机对照试验,采用RevMan4.2.10软件对入选试验进行Meta分析。结果共11项随机对照试验符合入选标准,有5项纳入益生菌与安慰剂对照试验,评价临床诱导缓解率;有7项纳入益生菌与安慰剂(3项)或美沙拉嗪(4项)对照试验,评价维持治疗中的复发率(有1项试验同时入选评价诱导缓解率及维持治疗的复发率)。Meta分析结果显示:①在合用传统药物的基础上,益生菌组的临床缓解率明显高于安慰剂(OR=0.28,95%CI0.16～0.49,P<0.00001);②在UC维持治疗中,益生菌组的复发率明显低于安慰剂组(OR=0.05,95%CI0.01～0.20,P<0.0001),与美沙拉嗪组相比无统计学差异(OR=0.99,95%CI0.68～1.45,P=0.98)。结论对于活动期UC患者,在应用传统药物治疗的同时合用益生菌制剂可明显提高临床缓解率;对于缓解期UC患者,益生菌制剂可作为维持治疗药物,其疗效与美沙拉嗪相当并优于安慰剂。

Objective To evaluate the effect of probiotics on inducing and maintaining remission of ulcerative colitis （UC）. Methods PubMed, EMBase, Web of Science and The Cochrane Central Register of Controlled Trials from 1966 to 2009 （up to August）, and China Journal Full-text Database, Chinese Technologic Journal Database （Weipu）, Wan Fang Digital Journal Full-text Database from 1978 to 2009 （up to August） were retrieved in order to collect clinical randomized controlled trials regarding the effect of probiotics in remission induction and maintenance in UC patients. Statistical analysis was performed by meta-analysis using Review Manager 4.2.10. Results Eleven randomized controlled trials met the inclusion criteria, of which five studies were included in the control trial of probiotics and placebo to evaluate the clinical remission rate, seven studies were included to compare probiotics with placebo （3 trials） or with mesalazine （4 trials） to evaluate the clinical relapse rate （one of the trials was included in the induction treatment group and the maintenance treatment group）. Meta-analysis showed that： a） On the basis of combining with conventional therapy, probiotics were superior to placebo in clinical remission rate （OR=0.28, 95%CI： 0.16-0.49, P0.00001）; b） In the maintenance treatment of UC, probiotics were superior to placebo （OR=0.05, 95%CI： 0.01-0.20, P0.0001） and no significant difference was observed between probiotics and masalazine （OR=0.99, 95%CI： 0.68-1.45, P=0.98）. Conclusions Combined with conventional therapy, probiotics can improve the clinical remission rate in paitents with active UC. In UC patients in remission, probiotics may be used to maintain the effect, and it is as efficacious as mesalazine, and is superior to placebo.