预防性使用益生菌对降低极低出生体重早产儿坏死性小肠结肠炎发病率和病死率的Meta分析

Prophylactic probiotics for preventing necrotizing enterocolitis and reducing mortality in very low birth weight infants: a Meta analysis

目的运用循证医学方法,评价益生菌在降低极低出生体重（VLBW）早产儿坏死性小肠结肠炎（NEC）的发病率和病死率方面的安全性和有效性。方法系统检索Pub Med、EMBASE、Cochrane临床对照试验资料库（CENTRAL）、the ISI Web of Knowledge Databases、中国生物医学文献数据库（CBM）、中文期刊全文数据库（CNKI）和维普中文科技期刊数据库（VIP）、万方数据库,检索时间均为建库至2014年3月,查找所有研究预防性使用益生菌对降低VLBW早产儿NEC的发病率和病死率的随机对照试验。按纳入排除标准进行RCT的筛选、资料提取和质量评价,应用Rev Man 5.1软件进行Meta分析。结果共纳入21项研究（4 607例VLBW早产儿）,Meta分析发现预防性使用益生菌能显著降低VLBW早产儿NEC的发病率[RR=0.47;95%CI（0.35~0.62）;P〈0.01]和总病死率[RR=0.63;95%CI（0.51~0.78）,P〈0.01];而益生菌使用组和对照组间败血症的发生率[RR=0.87;95%CI（0.72~1.06）;P=0.17]及NEC相关病死率[RR=0.68;95%CI（0.31~1.48）,P=0.33]差异无统计学意义。结论预防性使用益生菌能降低VLBW早产儿NEC的发病率和病死率,但其对早产儿的长期影响仍需大量的临床研究来评估。

Objective To systematically evaluate the efficacy and safety of probiotic supplementation for preventing necrotizing enterocolitis（NEC） and reducing mortality in preterm very low birth weight（VLBW） infants. Methods The randomized controlled trials（RCTs） about probiotics for preventing NEC in preterm neonates were searched in Pub Med, EMbase, Cochrane Central Register of Controlled Trials（CENTRAL）, the ISI Web of Knowledge databases, China Biology Medicine disc（CBM）, China National Knowledge Infrastructure（CNKI）, Weipu and Wanfang Data from their establishment to March 2014. The Cochrane Collaboration＇s Rev Man 5.1 Software was used for a Meta analysis. Results A total of 21 RCTs involving 4 607 preterm VLBW infants were eligible for inclusion in the Meta analysis. The Meta analysis showed that probiotic supplement was associated with a significantly decreased risk of NEC in preterm VLBW infants（RR=0.47; 95%CI： 0.35-0.62; P0.001）. Risk of mortality was also significantly reduced in the probiotic group（RR=0.63; 95%CI： 0.51-0.78; P0.01）. Probiotic supplement did not decrease the risk for sepsis（RR=0.87; 95%CI： 0.72-1.06; P=0.17） and NEC related mortality（RR=0.68; 95%CI： 0.31-1.48, P=0.33）. Conclusions The results confirm that probiotic supplement can reduce risk of NEC and mortality in preterm VLBW infants. However, the longterm effects and safety of probiotics need to be assessed in large trials.