乳酸菌对婴幼儿湿疹一级预防的系统评价

Meta analysis of lactic acid bacteria as probiotics for the primary prevention of infantile eczema

目的系统评价乳酸菌属益生菌对婴幼儿湿疹及特应性湿疹的一级预防作用。方法检索相关数据库中(检索时间到2010年1月)使用乳酸菌预防≤2岁婴幼儿湿疹和(或)特应性湿疹的随机对照试验(RCT),应用系统评价的方法进行质量评价,用RevMan5.0.2进行meta分析。结果共纳入了报道乳酸菌对婴幼儿湿疹发病预防作用的RCT12篇,其中7篇报道了对特应性湿疹的预防效果。Meta分析示:与对照组比较,乳酸菌组(单用及与其他益生菌合用)湿疹及特应性湿疹的发病率显著降低,RR值分别为0.80(95%CI:0.70～0.90,P<0.01),0.78(95%CI:0.64～0.97,P<0.01)。乳酸菌联合其他益生菌可显著减少湿疹发生,RR值为0.79(95%CI:0.68～0.93,P<0.01),而单独使用乳酸菌对湿疹无明显预防作用,其RR值为0.85(95%CI:0.69～1.05,P>0.05)。结论乳酸菌联合其他益生菌可预防婴幼儿湿疹的发生。目前证据未显示单独使用乳酸菌对婴幼儿湿疹的有预防作用,有待大规模的多中心RCT研究予以明确。

Objective To determine whether lactic acid bacteria as probiotics is efficacious in the primary prevention of infantile eczema or atopic eczema.Methods For this meta analysis of randomized controlled trials （RCT） describing the efficacy of probiotics in infants with eczema or atopic eczema at ages of ≤2 years,a comprehensive search in the databases was performed up to January 2010.Three reviewers independently evaluated the studies for methodological qualities.RevMan 5.0.2 software was used for meta analysis.Results Twelve RCTs on the preventive effects of lactic acid bacteria as probiotics on infantile eczema were included,and 7 of the 12 RCTs reported the preventive effect of lactic acid bacteria on atopic eczema.The meta analysis showed that there was an overall significant reduction in infantile eczema and atopic eczema favoring lactic acid bacteria compared with placebo.The relative risk （RR） ratios for eczema and atopic eczema were 0.80 （95% CI：0.70-0.90;P〈0.01） and 0.78 （95% CI：0.64-0.97;P〈0.01）,respectively.Lactic acid bacteria combined with other probiotics decreased significantly the incidence of eczema,with a RR ratio of 0.79 （95% CI：0.68-0.93;P〈0.01）.The use of lactic acid bacteria alone did not result in a reduction in the incidence of eczema,with a RR ratio of 0.85 （95% CI：0.69-1.05;P〈0.05）.Conclusions The data from this meta analysis suggest that lactic acid probiotics combined with other probiotics play a role in the prevention of infantile eczema.There is insufficient evidence to recommend single use of lactic acid bacteria for prevention of eczema.Further studies are required to determine whether the findings are reproducible.