益生菌对溃疡性结肠炎诱导缓解和维持治疗的Meta分析

摘要

目的：评价益生菌对溃疡性结肠炎（Ulcerative Colitis，UC）活动期诱导缓解及缓解期维持治疗的效果。方法计算机检索PubMed、EMBASE （1980年1月～2014年11月）外文数据库及中国期刊全文数据库、中文科技期刊数据库、万方数据库（1989年1月～2014年11月）等中文数据库，采用RevMan5.3软件对纳入文献进行Meta分析。结果共10篇文献符合标准，其中7篇入选益生菌治疗活动期UC组，5篇入选益生菌治疗缓解期UC组（有2篇同时入选以上2组）。纳入的10篇文献中有6篇提供了不良反应例数。系统评价结果：（1）对单独服用益生菌或安慰剂治疗活动期UC进行比较，益生菌组的诱导缓解率明显高于安慰剂组（RR=1.43，95%CI 1.14～1.80，P=0.002）；（2）对益生菌与美沙拉嗪合用糖皮质激素治疗活动期UC进行比较，益生菌组的诱导缓解率与美沙拉嗪组差异无统计学意义（95%CI -0.22～0.104，P=0.0508）；（3）对益生菌与美沙拉嗪维持治疗缓解期UC进行比较，益生菌组与美沙拉嗪组的复发率差异无统计学意义(RR=1.00，95%CI 0.79～1.2，P=0.98)；（4）益生菌组的不良反应发生率与对照组相比，其结果差异无统计学意义（RR=0.92，95%CI 0.74～1.15，P=0.47）。结论益生菌较安慰剂可明显提高活动期UC的临床缓解率；益生菌对缓解期UC维持治疗的疗效与美沙拉嗪相当；益生菌具有安全性好、不良反应少的优点。%Objective To evaluate the effect of probiotic on induced remission and maintenance treatment in active ulcerative colitis (UC). Methods Computerized retrieval PubMed, EMBASE (from January 1980 to November 2014) and CNKI,CSTJ,Wanfang data (from January 1989 to November 2014), Meta analysis was performed with RevMan 5.3 software.Results 10 articles were included, 7 articles were selected into probiotics treatment of UC active group,five articles were selected into probiotics treatment of UC remission group (there are 2 articles were included in the above two groups at the same time). In six of the 10 articles provides the adverse reactions occuring. System evaluation result:(1) To compare probiotic or placebo alone of active UC, induction remission rate ofprobiotic group was obviously higher than the placebo group (RR = 1.43, 95%CI 1.14 - 1.80,P = 0.002).(2) To compare probiotics or Mesalazine with traditional medicine of active UC, induced remission rate of probiotic group and Mesalazine had no statistical differences (95%CI 0.22 - 0.104,P = 0.0508).(3)To compare mesalazine and probiotics of maintain remission UC, the recurrence rate of mesalazine and probiotics had no statistical differences (RR = 1.00, 95%CI 0.79 - 1.2,P = 0.98).(4)The incidences of adverse reactions of probiotics and control group were no statistical differences (RR = 0.92, 95%CI 0.74 - 1.15,P = 0.47).Conclusion Probiotics can obviously increase the clinical remission rate of activity UC than placebo; The maintenance therapy effect of probiotics was no statistical differenceson with mesalazine for the remission of UC; Probiotics has good safety and less adverse reaction.