益生菌对婴儿期特应性皮炎预防作用的系统评价

Preventative effect of probiotics for infantile atopic dermatitis:A systematic review

目的系统评价益生菌对婴儿期特应性皮炎的预防作用。方法计算机检索中英文数据库,检索时限从建库到2017年12月,收集益生菌对婴儿期特应性皮炎预防的临床随机对照试验的文献,由2名研究员筛选文献及质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入质量较高的20个研究,共3 701例患儿。结果显示:益生菌组特应性皮炎发生率低于对照组,两组差异具有统计学意义(RR=0.74,95%CI:0.64~0.86,P<0.01)。进一步亚组分析后发现仅产前母亲或产后婴儿口服益生菌对婴儿期特应性皮炎无预防作用(RR=0.91,95%CI:0.62~1.33,P=0.62;RR=0.91,95%CI:0.71~1.16,P=0.43),而在两者均服用益生菌的比较中发现单独服用乳酸菌类或与其他益生菌混合服用同安慰剂组比较均具有预防作用(RR=0.70,95%CI:0.52~0.94,P<0.05;RR=0.65,95%CI:0.50~0.86,P<0.01)。结论孕母及产后婴儿均补充益生菌对婴儿期特应性皮炎具有预防作用,单独服用临床常用的乳酸菌类或与其他益生菌混合服用同样具有保护作用,但由于国内外菌株、种群差异等诸多因素,其对婴儿期特应性皮炎的保护机制在国内尚需进一步研究。

Objective To systematically evaluate the preventative effect of probiotics for infantile atopic dermatitis.Methods Databases were searched to collect the randomized controlled trials on probiotics in preventing infantile atopic dermatitis from inception to December 2017.Two reviewers independently screened the literatures,extracted the data and evaluated the quality.RevMan 5.3 software was used for meta-analysis.Results A total of 3,701 infants were included in 20 high-quality trials.The meta-analysis showed that the incidence rate of atopic dermatitis was lower in the probiotics group than in the placebo group with a significant difference（RR=0.74,95%CI：0.64-0.86,P0.01）.Further subgroup analysis showed that prenatal or postnatal probiotic supplementation alone had no preventive effect on atopic dermatitis（RR=0.91,95%CI：0.62-1.33,P=0.62;RR=0.91,95%CI：0.71-1.16,P=0.43）;both prenatal and postnatal lactobacillus alone or in combination with other probiotics had preventive effect（RR=0.70,95%CI：0.52-0.94,P0.05;RR=0.65,95%CI：0.50-0.86,P0.01）.Conclusion Probiotics supplementation for pregnant mothers and postpartum infants has a preventive effect on infantile atopic dermatitis,whether used alone or in combination with other probiotics.Due to the differences of probiotics at home and abroad in some aspects such as probiotic strain and species,etc.,their specific effects on infantile atopic dermatitis should be further studied.