益生菌酸奶对机体血脂水平影响的Meta分析

Effect of Probiotic Yogurt on Body's Blood Plasma Lipid Levels: A Meta-analysis

目的系统评价益生菌酸奶对成年人机体血脂水平的影响。方法计算机检索Cochrane Library、Web of Science、PubMed、EMBase、维普网、中国知网、中国生物医学文献数据库、万方数据知识服务平台,检索时限为1999年1月—2016年2月,纳入应用益生菌酸奶与脂代谢关系的随机对照试验。由两位研究人员独立筛选文献、提取数据,并评价纳入文献的偏倚风险。采用RevMan 5.3软件对益生菌酸奶对总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和三酰甘油(TG)水平的影响进行分析。结果最终纳入12篇文献,共13项研究,包括606例研究对象,其中益生菌酸奶组305例,传统酸奶组301例。Meta分析结果显示,益生菌酸奶组TC、LDL-C、TG水平均低于传统酸奶组,差异有统计学意义〔MD=-8.43,95%CI(-10.28,-6.58),P<0.001;MD=-6.34,95%CI(-10.06,-2.62),P<0.001;MD=-6.10,95%CI(-10.32,-1.87),P<0.001〕。益生菌酸奶组和传统酸奶组HDL-C水平比较,差异无统计学意义〔MD=1.29,95%CI(-0.67,3.25),P=0.20〕。两种干预方法比较的HDL-C、LDL-C在不同文献间存在明显的统计学异质性,经敏感性分析,剔除观察时间较长和漏斗图显示可能存在异质性的文献后,结果显示,益生菌酸奶组和传统酸奶组HDL-C、LDL-C水平比较,差异均有统计学意义〔MD=1.50,95%CI(1.12,2.87),P<0.001;MD=-4.73,95%CI(-8.97,-0.48),P=0.03〕。对有关HDL-C的文献绘制漏斗图,结果显示,散点左右大致对称,表明存在发表偏倚的可能性较小。结论与传统酸奶相比,益生菌酸奶能有效改善机体的血脂水平。受纳入文献的质量和数量的影响,本结论仍需高质量的试验进一步证实。

Objective To systematically evaluate the effect of probiotic yogurt on plasma lipid in adults. Methods Databases including the Cochrane Library, Web of Science, Pub Med, EMBase, VIP, CNKI, CBM and Wanfang Database from January 1999 to February 2016 were searched by computer. Randomized control trial on the relationship between probiotic yogurt and lipid metabolism were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria,then extracted data and evaluated biased risk of the included literature. The effect of probiotic yogurt on total cholesterol（ TC）, high-density lipoprotein cholesterol（ HDL-C）, low-density lipoprotein cholesterol（ LDL-C） and triglyceride（ TG） were analyzed using Rev Man 5. 3 software. Results A total of 13 studies in the 12 literatures were included,including 606 subjects（ 305 in the probiotic yogurt group and 301 in the traditional yogurt group）. The results of meta-analysis showed that the levels of TC 〔MD =-8. 43,95% CI（-10. 28,-6. 58）,P〈0. 001 〕,LDL-C 〔MD =-6. 34,95% CI（-10. 06,-2. 62）,P〈0. 001〕and TG 〔MD =-6. 10,95% CI（-10. 32,-1. 87）,P〈0. 001〕in the probiotic yogurt group were significant lower than those in traditional yogurt group. There was no statistically significant difference in the HDL-C level between probiotic yogurt group and traditional yogurt group 〔MD = 1. 29,95% CI（-0. 67,3. 25）,P = 0. 20 〕. Therewere significant statistical heterogeneity about the levels of HDL-C and LDL-C between the two intervention methods in the different literatures. The longer observation time and possible heterogeneity literatures were deleted using sensitivity analysis.The result showed that there were statistically significant difference in the levels of HDL-C and LDL-C between the probiotic yogurt group and traditional yogurt group 〔MD = 1. 50,95% CI（ 1. 12,2. 87）, P〈0. 001; MD =-4. 73,95% CI（-8. 97,-0. 48）,P = 0. 03〕. The funnel plot of the literatures about HDL-C was roughly symmetrical and indicated that there was less possibility of publication bias. Conclusion Compared with the traditional yogurt,probiotic yogurt can effectively improve the level of blood plasma lipids. However,due to the influence of quality and quantity of the included literatures,this conclusion still needed high-quality experiments to further confirm.