益生菌对孤独谱系障碍患者核心症状干预效果的荟萃分析

Meta-analysis of the effect of probiotics on core symptoms of children with autism spectrum disorder

目的评价益生菌对孤独谱系障碍(ASD)患者核心症状的治疗效果,为ASD的治疗和干预提供理论依据。方法计算机检索中国生物医学文献服务系统(SinoMed)、万方数据知识服务平台、维普引文数据库和中国知网,英文数据库包括PubMed、Embase和Web of Science共7个数据库中有关益生菌干预孤独谱系障碍患者核心症状影响的文献,检索期限为2000年1月到2023年5月。采用Rev Man5.4进行Meta分析,计算效应量合并异质性检验敏感性分析和亚组分析。结果共纳入10项研究343名患者。Meta分析显示,对于ASD核心症状得分干预组与对照组间差异有统计学意义(SMD=-0.34,95%CI:-0.55~-0.12,P<0.05),亚组分析显示,在亚洲人种中展开的试验疗效不显著(SMD=-0.32,95%CI:-0.63~0.00,P=0.05),而在高加索人种中疗效显著(SMD=-0.35,95%CI:-0.65~-0.06,P<0.02)。按年龄分组,发现包含成人的试验疗效不显著(SMD=-0.12,95%CI:-0.57~0.33,P=0.61),只包含未成年人的试验中疗效显著(SMD=-0.40,95%CI:-0.65~-0.16,P=0.007)。按疗程分组,干预不超过3个月(SMD=-0.35,95%CI:-0.66~-0.03,P<0.05)和超过3个月(SMD=-0.33,95%CI:-0.62~-0.03,P<0.05)的疗效均显著。按菌株分组,单一菌群疗效不明显(SMD=-0.16,95%CI:-0.46~0.15,P>0.05),复合菌群疗效显著(SMD=-0.51,95%CI:-0.81~-0.21,P<0.05)。结论益生菌治疗对于改善ASD患者的核心症状有效,但受人种、年龄和菌株等因素影响,在高加索人种、未成年人群中使用复合菌群的条件下有更好的疗效。

Objective To evaluate the therapeutic effect of probiotics on core symptoms in patients with autism spectrum disorder(ASD),in order to provide theoretical basis for the treatment and intervention of ASD.Method Articles published from January 2000 to May 2023 on the effect of probiotics on core symptoms in ASD children were retrieved from 7 databases,including Chinese Biomedical Literature Service System(SinoMed),Wanfang Data Knowledge Service Platform,VIP Citation Database,and China National Knowledge Infrastructure(CNKI),PubMed,Embase,and Web of Science.Meta-analysis was performed using RevMan 5.4.Effect size,combine heterogeneity test sensitivity analysis and subgroup analysis were calculated.Result Totally 10 studies with 343 patients were included in this Meta-analysis.Meta-analysis showed that there was statistically significant difference in ASD core symptom score between the intervention group and the control group(SMD=-0.34,95%CI:-0.55--0.12,P<0.05).Subgroup analysis showed that the efficacy of the trial conducted in Asian populations was not significant(SMD=-0.32,95%CI:-0.63-0.00,P=0.05).In Caucasian populations,the therapeutic effect was significant(SMD=-0.35,95%CI:-0.65--0.06,P<0.05).Grouped by age,it was found that the efficacy was not significant in trials involving adults(SMD=-0.12,95%CI:-0.57-0.33,P=0.61),but significant in trials involving only minors(SMD=-0.40,95%CI:-0.65--0.16,P<0.05).According to the treatment course grouping,the intervention for less than 3 months(SMD=-0.35,95%CI:-0.66--0.03,P<0.05)and more than 3 months(SMD=-0.33,95%CI:-0.62--0.03,P<0.05)showed significant therapeutic efficacy.Grouped by bacterial strains,the efficacy of a single microbial community was not significant(SMD=-0.16,95%CI:-0.46-0.15,P>0.05),while the efficacy of a composite microbial community was significant(SMD=-0.51,95%CI:-0.81--0.21,P<0.05).Conclusions Probiotic therapy is effective in improving the core symptoms of ASD patients,but is influenced by factors such as race,age and probiotic strain.Composite microbiota has better efficacy in Caucasian and underage populations.