Evidence-based medicine suggested that probiotic treatment was more effective than placebo in maintaining remission in ulcerative colitis (UC) , but did not provide additional benefit in inducing remission. However, two clinical trials published in 2009 showed that VSL#3 , a probiotic mixture, was effective for the induction of remission in UC. Aims; To systematically evaluate the effectiveness and safety of probiotics, especially VSL#3 for induction of remission in UC. Methods; MEDLINE, EMBASE, Cochrane Library, CBM and Wanfang Data were searched for randomized controlled trials comparing the induction of remission in UC between probiotics treatment and non-probiotics treatment (placebo or positive control) without language limitation. Information was retrieved by two reviewers independently. RevMan 5. 2. 10 software was used to perform meta-analysis; subcategory analysis and sensitivity analysis were also performed. Results; Nine randomized controlled trials with a total of 557 UC patients met the inclusion criteria, of which 4 were VSL#3 treatment. From meta-analysis, the odds ratio of probiotics treatment for induction of remission was 2.05 (95% CI; 1. 14-3.70, P =0. 02) when compared with non-probiotics treatment. Subcategory analysis showed that the odds ratio of VSL#3 treatment was 2.35 (95% CI: 1. 45-3. 80, P = 0. 0005 ) , while nonsignificant odds ratios were seen for other probiotics. The adverse effect rate was not significantly different between probiotics/VSL#3 treatment and non-probiotics treatment. Sensitivity analysis showed that the result of pooled analysis of the nine trials was stable. Conclusions; VSL#3 is safe and superior to non-probiotics treatment for induction of remission in UC.%背景:循证医学证据提示益生菌对溃疡性结肠炎(UC)的诱导缓解无效,但对维持缓解有效,然而2009年发表的两项临床试验结果显示益生菌合剂VSL#3对UC的诱导缓解有效.目的:系统评价益生菌尤其是VSL#3诱导UC缓解的有效性和安全性.方法:联机检索MEDLINE、EMBASE、Cochrane Library和中国生物医学文献数据、万方数据库,由两名分析人员独立选取与UC诱导缓解相关、比较益生菌治疗组与对照组(安慰剂或阳性对照)的随机对照试验(不限语种)并提取数据.应用RevMan 5.2.10软件行meta分析,同时行亚组分析和敏感性分析.结果:共纳入9项随机对照试验,共557例UC患者,其中4项治疗组使用VSL#3.Meta分析显示益生菌组总体诱导缓解率显著优于对照组(OR=2.05,95％ CI:1.14～3.70,P=0.02),亚组分析显示VSL#3亚组诱导缓解率显著优于对照组(OR:2.35,95％ CI:1.45 ～3.80,P=0.0005),其他菌种与对照组间诱导缓解率无明显差异.益生菌组、VSL#3亚组与对照组间不良反应发生率均无明显差异.敏感性分析显示meta分析结果稳定.结论:VSL#3对UC的诱导缓解作用优于对照组且安全性高.
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