益生菌治疗类风湿关节炎的meta分析和试验序贯分析

Probiotics in the treatment of rheumatoid arthritis:meta analysis and trial sequential analysis

目的系统评价益生菌治疗类风湿关节炎的临床疗效。方法检索中国生物医学数据库、中国知网、万方、维普、Embase、PubMed、the Cochrane Library、Web of Science数据库,时间均从建库至2021年7月,对公开发表的益生菌治疗类风湿关节炎的随机对照试验进行meta分析和试验序贯分析。结果共纳入6项研究,总样本量242例。Meta分析显示,益生菌治疗类风湿关节炎能显著降低CRP[MD=-2.26,95%CI=(-4.30,-0.23),P=0.03]和TNF-α[MD=-1.78,95%CI=(-2.73,0.83),P<0.01]水平,提高IL-10[MD=3.80,95%CI=(0.40,7.19),P=0.03]水平,而ESR、IL-1β、IL-6、MDA、TAC、DAS28、TJC、SJC、HAQ和ACR20等水平均与安慰剂相当。敏感性分析显示结果较为稳健,试验序贯分析显示CRP的获益具有结论性,Egger检验显示不存在发表偏倚(P=0.17)。结论益生菌能够有效降低CRP和TNF-α水平,提高IL-10水平,具有治疗类风湿关节炎的潜力。

Objective To systematically evaluate the clinical efficacy of probiotics in the treatment of rheumatoid arthritis(RA).Methods The CMB,CNKI,WanFang,VIP,Embase,PubMed,the Cochrane Library and Web of Science databases were searched from the establishment of the database to July 2021.The published randomized controlled trials(RCTs)on probiotics in the treatment of RA were analyzed by using meta analysis and trial sequential analysis.Results Six studies were included,with a total sample size of 242 cases.Meta analysis showed that probiotics could significantly reduce CRP[MD=-2.26,95%CI=(-4.30,-0.23),P=0.03]and TNF-α[MD=-1.78,95%CI=(-2.73,0.83),P<0.01]in the treatment of RA,and increase IL-10[MD=3.80,95%CI=(0.40,7.19),P=0.03],while ESR and IL-1β,IL-6,MDA,TAC,DAS28,TJC,SJC,HAQ and ACR20 were equivalent to those of placebo.Sensitivity analysis showed that the results were robust;trial sequential analysis showed that the benefit to CRP was conclusive,and Egger test showed no publication bias(P=0.17).Conclusion Probiotics can effectively reduce CRP and TNF-α,and increase IL-10,which has the potential to treat rheumatoid arthritis.