益生菌治疗肠易激综合征疗效的Meta分析

Efficacy of probiotics in treatment of irritable bowel syndrome:a meta-analysis

目的探讨益生菌治疗肠易激综合征(IBS)的临床疗效及安全性。方法计算机检索PubMed、国际Cochrane中心、Embase、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、维普数据库,收集益生菌治疗IBS的随机对照试验(RCT),并手工检索已获文献的参考文献,由两位评价者按照纳入和排除标准筛选、提取资料并行方法学质量评价,采用RevMan 5.0软件对数据行Meta分析。结果共纳入19个RCT,2172例患者。Meta分析结果显示,益生菌较安慰剂在改善患者总体症状积分[SMD=-0.18,95%CI(-0.28,-0.08),P=0.000 6]、腹痛[SMD=-0.13,95%CI(-0.21,-0.04),P=0.0031、腹胀[SMD=-0.15,95%CI(-0.25,-0.05),P=0.004]、排便不适感[SMD=-0.15,95%CI(-0.27,-0.02),P=0.02】方面均有显著意义,在总体生活质量[SMD:0.09,95%CI(-0.08,0.25),P=0.301、不良反应发生率[RR=0.91,95%CI(0.71,1.16),P=0.45]方面无显著意义。结论目前证据显示益生菌制剂能有效改善IBS患者的临床症状,且安全性好,但现有RCT在方法质量学以及研究设计上存在一定不足,今后的研究应在菌株、剂量、疗程、IBS亚组患者方面进行严谨、高质量、大样本长期随访的临床研究予以证实。

AIM To evaluate the efficacy and safety of probiotics in the treatment of irritable bowel syndrome （IBS）. METHODS Original literatures were identified by searching the PubMed, Cochrane center register of controlled trials, Embase, CBM, CNKI, WanFang, WeiPu were searched from establishment to March of 2013. Meanwhile, the references of the included literatures were hand-searched to collect randomized controlled trials （RCTs） on probiotics for treating IBS. Data extraction and quality evaluation were completed accordance with the inclusion and exclusion criteria by two researchers. RevManS.0 software was used for data analyses. RESULTS Nineteen RCTs involving 2 172 patients were included. The result of meta-analyses showed that compared with placebo, there was statistical significant in improving overall symptoms integral [SMD = -0.18, 95%CI （-0.28, -0.08）, P = 0.000 6], abdominal pain [SMD = -0.13, 95%CI （-0.21, -0.04）, P = 0.003], abdominal distension [SMD = -0.15, 95%CI （-0.25, -0.05）, P = 0.004], defecation discomfort ]SMD = -0.15, 95%C/ （-0.27, -0.02）, P = 0.02]. There was no statistical significance in the overall quality of life [SMD = 0.09, 95%CI （-0.08, 0.25）, P = 0.30], adverse effect ratio [RR = 0.91, 95%CI （0.71, 1.16） , P = 0.45]. CONCLUSION The current evidence shows that probiotics can effectively improve the clinical symptoms of IBS patients and has a good security. However, there was an inadequacies due to methodological quality problems in existing RCTs, so future studies need more rigorous, well-designed, large sample size RCTs focus on strains, dosage, course of treatment, patients with IBS subgroups to confirm their effectiveness.