LFD治疗炎症性肠病疗效的Meta分析

Efficacy of low FODMAP diet in the treatment of inflammatory bowel disease:a meta-analysis

目的系统评价LFD对炎症性肠病(IBD)胃肠症状及炎症指标的有效性。方法计算机检索The Cochrane Library、Embase、PubMed、Web of Science、中国知网、中国生物医学文献及万方数据库,对炎症性肠病患者采用低FODMAP饮食的随机对照实验(RCT)检索收集,检索时间均从各数据库建库至2022年4月。由2位评价员独立筛选文献、提取文献数据并对纳入文献进行偏倚风险评价,采用Review Manager 5.4软件进行Meta分析。结果共纳入4项RCT研究,共包括205例患者。Meta分析结果显示:与对照组饮食相比,LFD可缓解IBD患者胃肠道症状(RR=0.49,95%CI:0.34~0.70,P<0.0001),按照疾病类型进行亚组分析,结果表明CD患者(RR=0.53,95%CI:0.32~0.87,P=0.01)和UC患者(RR=0.54,95%CI:0.35~0.85,P=0.007)胃肠症状均有明显改善。LFD可使IBD患者获得更高的IBD-Q评分(MD=4.81,95%CI:1.98~7.64,P=0.0009)和更低的IBS-SSS评分(MD=-50.67,95%CI:-95.53~-5.80,P=0.03),而LFD对IBD患者粪便CRP、FC及CD患者HBI评分和UC患者Mayo评分无统计学意义。结论LFD对IBD患者胃肠道症状和生活质量有益,但对疾病炎症指标缓解没有明显的作用。

Objective To evaluate the efficacy of Low FODMAP Diet(LFD)on gastrointestinal symptoms and inflammatory markers in patients with inflammatory bowel disease(IBD).Methods PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,CBM and WanFang Data were searched by computer.Randomized controlled trials(RCT)of LFD in patients with IBD were collected from the establishment of the database to April 2022.Two reviewers independently screened the literature,extracted literature data,and evaluated the risk of bias of the included literature.Meta-analysis was performed using Review Manager 5.4 software.Results A total of 4 RCT were included,including 205 patients.Meta-analysis results showed that:Compared with the control group,LFD could alleviate gastrointestinal symptoms in IBD patients(RR=0.49,95%CI:0.34-0.70,P<0.0001).Subgroup analysis according to disease type showed that CD patients(RR=0.53,95%CI:0.32-0.87,P=0.01)and UC patients(RR=0.54,95%CI:0.35-0.85,P=0.007)showed significant improvement in gastrointestinal symptoms without significant difference.LFD could make IBD patients get higher IBD-Q score(MD=4.81,95%CI:1.98-7.64,P=0.0009)and lower IBS-SSS score(MD=-50.67,95%CI:-95.53--5.80,P=0.03).However,LFD had no significant effect on fecal CRP,FC and HBI scores of IBD patients and Mayo scores of UC patients.Conclusion LFD is beneficial to gastrointestinal symptoms and quality of life in IBD patients,but has no significant effect on the remission of inflammatory markers of the disease.