益生菌预防儿童腹泻的效果研究—基于随机对照试验研究的meta分析

Effects of probiotic for preventing pediatric diarrhea:meta-analysis of randomized controlled trials

目的评价益生菌预防儿童腹泻发生的有效性。方法在Pubmed,Embase,Clinical Trials.gov,Cochrane Library等数据库系统检索截至目前发表的所有采用益生菌预防儿童腹泻的随机对照试验研究(RCT),排除益生菌对治疗儿童腹泻相关的RCT。采用随机效应模型合并不同研究的相对危险度,采用森林图及Egger检验判断发表偏倚,并采用I2来检验异质性大小,采用亚组分析判断益生菌对所有抗生素相关腹泻、艰难梭菌相关腹泻以及轮状病毒腹泻的预防效果。结果最终共纳入20篇RCT研究,共有1977名儿童预防性服用了益生菌,并有1947名中儿童服用安慰剂等对照措施。研究结果表明:儿童预防性服用益生菌,相比安慰剂等对照措施,能显著减少51%的腹泻发生率,相对危险度(RR)值为0.49,95%置信区间(CI):0.39~0.62,P<0.001;其中抗生素相关腹泻发生率显著减少59%,(RR=0.41,95%CI:0.29~0.59,P<0.001);艰难梭菌相关腹泻及轮状病毒相关腹泻发生率分别减少66%(RR=0.34,95%CI:0.15~0.76,P=0.008)和37%(RR=0.63,95%CI:0.43~0.92,P=0.016)。结论儿童预防性服用益生菌,能显著减少腹泻的发生,尤其是抗生素相关腹泻,包括艰难梭菌相关腹泻及轮状病毒相关腹泻。

Objective To evaluate the effects of probiotic for preventingpediatricdiarrhea. Methods Original randomized controlled trials （RCTs） which focus on the effects of probiotic for preventing pediatric diarrheawere systematically searched in the Pubmed, Embase, ClinicalTrials. gov, and Coehrane Library. The pooled relative risk （RR） of probiotic for preventing pediatric diarrhea against placebo was calculated using random-effects model. Funnel plot and Egger＇ s test were used to detect potential publication bias. 12 was used to evaluate the heterogeneity betweenincluded studies. Subgroup analyses were used to explore the effects of probiotic for preventing antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and rotavirus diarrhea among children. Results A total of 20 RCTs were included. A total of 1977children received prophylactic probiotic treatment, while 1947children received placebo or other treatments. After pooling RRs from included studies, compared with placebo and other treatments, probiotic treatment could significantly reduce 51% diarrhea （ RR ： O. 49, 95% confidential intervals （ CIs ） ： 0. 39-0.62, P 〈0. 001 ）. The antibiotic-associated diarrhea significantly decreased 59% （ RR： 0. 41,95% CI： O. 29-0. 59, P 〈 0. 001 ）. And Clostridium difficile-associated diarrheaand rotavirus diarrhea decreased66% （RR： 0.34,95% CI：0. 15-0.76, P = 0. 008 ） and 37% （RR： 0.63,95% CI： 0. 43-0.92, P = 0. 016 ）, respectively. Condusions Probiotic treatment could significantly reduce pediatric diarrhea, especially for antibiotic-associated diarrhea, including Clostridium difficile-associated diarrheaand rotavirus diarrhea.