孕期及婴幼儿期补充益生菌预防儿童特应性皮炎效果的Meta分析

Effect of probiotic supplementation during pregnancy and infancy in preventing atopic dermatitis in children: a Meta analysis

目的系统评价孕期及婴幼儿期补充益生菌预防儿童特应性皮炎的效果。方法运用RevMan5.3软件,对2008年1月至2018年5月国内外发表的有关孕期及婴幼儿期使用益生菌预防儿童特应性皮炎的随机对照试验研究进行Meta分析,并按干预菌株、随访时间、补充益生菌时间、研究地区进行亚组分析。结果最终纳入22篇文献,干预组和对照组病例分别为3 280例和3 281例。合并效应量结果显示,孕期和/或婴幼儿期使用益生菌可减少儿童特应性皮炎的发生(RR=0.81,95%CI:0.70～0.93,P<0.05)。亚组分析结果显示,使用乳酸杆菌和双歧杆菌混合菌株干预效果显著(RR=0.68,95%CI:0.52～0.90,P<0.05);孕期及婴幼儿期均补充益生菌效果显著(RR=0.77,95%CI:0.66～0.90,P<0.05);孕期和/或婴幼儿期补充益生菌预防特应性皮炎对≤2岁儿童效果较显著(RR=0.74,95%CI:0.61～0.90),而对2岁以上儿童效果不显著;研究地区为澳洲或欧洲/美国的效果显著(P<0.05),合并RR及95%CI分别为0.83(95%CI:0.73～0.96)、0.74(95%CI:0.61～0.91)。异质性主要源于不同随访时间(I^2=62.7%)和补充益生菌时间(I^2=53.5%)。结论孕期及婴幼儿期补充益生菌有利于预防儿童特应性皮炎的发生,其中使用乳酸杆菌和双歧杆菌混合菌株干预效果显著。

Objective To systematically review the effect of probiotic supplementation during pregnancy and infancy in preventing atopic dermatitis in children. Methods RevMan5.3 was used to perform a Meta analysis of randomized controlled trials on the effect of probiotic supplementation during pregnancy and infancy in preventing atopic dermatitis in children published between January 2008 and May 2018 across the world. A subgroup analysis was conducted according to the type of probiotics for intervention, follow-up time, time of probiotic supplementation, and study areas. Results A total of 22 articles were selected, with 3 280 cases in the intervention group and 3 281 cases in the control group. The results of pooled effect size showed that probiotic supplementation during pregnancy and/or infancy significantly reduced the incidence rate of atopic dermatitis (RR=0.81, 95% CI:0.70-0.93, P < 0.05). According to the subgroup analysis, the intervention with Lactobacillus and Bifidobacterium had a significant effect (RR=0.68, 95% CI:0.52-0.90, P < 0.05);probiotic supplementation during both pregnancy and infancy also had a significant effect (RR=0.77, 95% CI:0.66-0.90, P < 0.05);probiotic supplementation during pregnancy and/or infancy had a better effect in preventing atopic dermatitis in children aged ≤ 2 years than in those aged > 2 years (RR=0.74, 95% CI:0.61-0.90, P < 0.05);probiotic supplementation had a significant effect in Australia (RR=0.83, 95% CI:0.73-0.96, P < 0.05) and Europe/the United States (RR=0.74, 95% CI:0.61-0.91, P < 0.05). Heterogeneity was mainly due to follow-up time (I^2=62.7%) and time of probiotic supplementation (I^2=53.5%). Conclusions Probiotic supplementation during pregnancy and infancy helps to prevent atopic dermatitis in children, and mixed Lactobacillus-Bifidobacterium intervention has a better effect.