益生菌制剂治疗轻微型肝性脑病的荟萃分析

Efficacy of probiotics in the treatment of minimal hepatic encephalopathy:a metaanalysis

目的:评价益生菌制剂治疗轻微型肝性脑病(minimal hepatic encephalopathy,MHE)的疗效.方法:检索PubMed、EMBASE、WebofScience、The Cochrane Central Register of Controlled Trials、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关于益生菌制剂治疗MHE的临床随机对照试验(RCT),使用Cochrane图书馆提供的Review Manager4.3软件对入选试验进行荟萃分析.结果:共9项试验满足纳入标准而入选本研究,荟萃分析表明:与对照组相比,益生菌制剂可明显缩短数字连接试验(NCT)反应时间(WMD=13.60,95%CI:1.53-25.66,P=0.03),有效降低血氨水平(SMD=0.98,95%CI:0.25-1.71,P=0.008),减轻内毒素血症(SMD=1.03,95%CI:0.65-1.42,P<0.00001),改善ALT水平(WMD=11.72,95%CI:5.57-17.88,P=0.0002),并降低临床肝性脑病的发生率(RR=0.15,95%CI:0.05-0.41,P=0.0002).结论:益生菌制剂可改善MHE患者临床及部分生化指标,降低MHE发展为临床肝性脑病的几率,有可能成为MHE治疗的新选择.

AIM：To evaluate the efficacy of probiotics in the treatment of minimal hepatic encephalopathy.METHODS：PUBMED,EMBASE,Web of Science,The Cochrane Central Register of Controlled Trials,Chinese Journals Full-text Database,Chinese Biomedical Database and Wan Fang Digital Journal Full-text database were searched to retrieve randomized controlled trials evaluating the eff icacy of probiotics in the treatment of minimal hepatic encephalopathy.Statistical analysis was performed using Review Manager 4.3.RESULTS：Nine randomized controlled trials were included.Compared to the control group,probiotics significantly decreased serum ammonia（SMD = 0.98,95%CI：0.25-1.71,P = 0.008）,endotoxin（SMD = 1.03,95%CI：0.65-1.42,P 0.00001） and ALT（WMD = 11.72,95%CI：5.57-17.88,P = 0.0002）,shortened the time of number connection test（NCT）（WMD = 13.60,95%CI：1.53-25.66,P = 0.03）,and reduced morbidity of clinical hepatic encephalopathy（RR = 0.15,95%CI：0.05-0.41,P = 0.0002）.CONCLUSION：Probiotics can significantly improve some clinical and biochemical parameters in patients with minimal hepatic encephalopathy,decrease the morbidity of clinical hepatic encephalopathy and may become a new choice for the treatment of minimal hepatic encephalopathy.