益生菌对哮喘的预防及治疗作用的系统评价
发布时间：2021-10-17 04:12
目的对益生菌对哮喘的预防及治疗作用进行系统评价,为临床上益生菌的合理应用提供依据。方法计算机检索中国知网、中国生物医学文献数据库、重庆维普、万方数据知识服务平台、PubMed、Embase、Cochrane Library、Web of Science等数据库建库至2019年2月的所有相关文献,并手工检索相关文献的参考文献。使用Cochrane偏倚风险评估工具对纳入研究进行评价。结果益生菌对哮喘预防作用的系统评价纳入12项研究,结果显示益生菌对哮喘（RR=0.95,95%CI=0.82～1.11）及喘息（RR=0.99,95%CI=0.88～1.11）的发生无预防作用。针对各干预细节进行亚组分析后结果无差异。益生菌对哮喘治疗作用的系统评价纳入6项研究,结果显示益生菌对哮喘患者的肺功能及哮喘控制水平有改善作用,但尚需更多研究对此进行证实;益生菌对哮喘患者的免疫学指标及哮喘药物使用等的影响尚需更多研究进行探讨。结论基于现有证据,本研究显示益生菌对哮喘及喘息的发生无预防作用;益生菌对哮喘患者的肺功能及哮喘控制水平可能有改善作用,但未来还需更多研究证实。
【文章来源】：中国医学科学院学报. 2020,42(02)北大核心CSCD
【文章页数】：12 页
【部分图文】：
益生菌预防哮喘相关研究偏倚风险评价
表2 益生菌治疗哮喘相关文献基本特征Table 2 Characteristics of included studies on the role of probiotic supplementation in asthma treatment 纳入研究Included studies 干预人群Intervention populations 干预Intervention 疗程Intervention duration 结局指标Outcome indicators 益生菌组Probiotic group 对照组Control group Giovannini等2007[34] 儿童Children 干酪乳杆菌 DN- 114 001 1×1010 cfu/d、保加利亚乳杆菌 1×109 cfu/d、嗜热链球菌 1×1010 cfu/dLactobacillus casei DN- 114 001 1×1010 cfu/d,lactobacillus bulgaricus 1×109 cfu/d,streptococcus thermophilus 1×1010 cfu/d(n=62) 安慰剂Placebo(n=57) 12个月12 months 哮喘及鼻炎的无症状持续时间、急性发作次数、发作平均持续时间、不良反应、免疫指标等Time free from episodes of asthma and/or rhinitis;cumulative number and duration of episodes;side effects;immunologic parameters Gutkowski等2010[33] 儿童Children 嗜酸乳杆菌、两歧双歧杆菌、德氏乳杆菌保加利亚亚种,共3.2×109 cfu/dLactobacillus acidophilus,bifidobacterium bifidum,lactobacillus delbrueckii subsp. bulgaricus,3.2×109 cfu/d in total(n=22) 安慰剂Placebo(n=24) 3个月3 months 哮喘急性发作次数、支气管扩张剂使用情况、肺功能、不良反应、免疫指标等Asthma exacerbations;bronchodilators usage;lung function;side effects;immunologic parameters Chen等2010[32] 儿童Children 加塞乳酸杆菌A5 4×109 cfu/dLactobacillus gasseri A5 4×109 cfu/d(n=49) 安慰剂Placebo(n=56) 2个月2 months 日间、夜间哮喘症状评分、肺功能、哮喘控制情况、免疫指标等The day and nighttime symptoms of asthma;lung function;asthma control;immunologic parameters Van De Pol等2011[31] 成人Adults 短双歧杆菌M- 16V 1×1010 cfu、短链低聚半乳糖/长链低聚果糖混合物 (7.2∶0.8 g),每日两次Bifidobacterium breve M- 16V 1×1010 cfu,short-chain galacto-oligosaccharides / long-chain fructo-oligosaccharides mixture (7.2∶0.8 g),twice daily(n=14) 安慰剂Placebo(n=15) 1个月1 month 诱导痰嗜酸性粒细胞计数、肺功能、免疫指标、不良反应等Eosinophil counts in sputum;lung function;immunologic parameters;side effects Ahanchian等2016[30] 儿童Children 干酪乳杆菌、鼠李糖乳杆菌、嗜热链球菌、短双歧杆菌、嗜酸乳杆菌、婴儿双歧杆菌、保加利亚乳杆菌,共1×109 cfu/d;低聚果糖Lactobacillus casei,lactobacillus rhamnosus,streptococcus thermophiles,bifidobacterium breve,lactobacillus acidophilus,bifidobacterium infantis,lactobacillus bulgaricus,1×109 cfu/d in total;fructooligosacharide (n=36) 安慰剂Placebo(n=36) 2个月2 months 呼吸道病毒感染次数、沙丁胺醇及泼尼松龙的使用情况、缺课、门诊及住院次数、不良反应等Number of viral respiratory infections;salbutamol and prednisolone usage;school absence;outpatient visits and hospital admission for asthma;side effects Huang等2018[29] 儿童Children 干预组1:副干酪乳杆菌GMNL- 133 (n=38);干预组2:发酵乳杆菌GM- 090 (n=38);干预组3:副干酪乳杆菌GMNL- 133 + 发酵乳杆菌GM- 090 (n=36)Group 1:lactobacillus paracasei GMNL- 133 (n=38);group 2:lactobacillus fermentum GM- 090 (n=38);group 3:lactobacillus paracasei GMNL- 133 + lactobacillus fermentum GM- 090(n=36) 安慰剂Placebo(n=35) 3个月3 months 哮喘严重程度、哮喘控制情况、哮喘患儿生活质量、肺功能、药物使用、免疫指标等Asthma severity;asthma control;pediatric asthma quality of life;lung function;medication use;immunologic parameters图3 益生菌对哮喘的预防作用
图2 益生菌治疗哮喘相关研究偏倚风险评价表3 益生菌对哮喘的预防作用的亚组分析Table 3 Subgroup analyses of the role of probiotic supplementation in asthma prevention 亚组Subgroup 研究数目No. of studies RR(95%CI) I2(%) 研究所处地区Geographical area 欧洲Europe 8 0.95(0.77- 1.16) 20.4 其他Others 4 0.96(0.77- 1.21) 0 干预对象Intervention populations 母亲Mothers 1 3.20(0.34- 30.38) -a 婴儿Infants 5 0.81(0.59- 1.11) 13.3 母亲及婴儿Mothers and infants 6 0.99(0.83- 1.18) 0 婴儿哮喘发生风险Infant asthma risk 高风险人群High risk population 10 0.94(0.81- 1.10) 1.3 一般人群Unselected population 2 1.32(0.54- 3.19) 0 干预时机Timing of intervention 产后Postnatal 5 0.81(0.59- 1.11) 13.3 产前和产后Prenatal and postnatal 7 1.00(0.84- 1.19) 0 益生菌种类b Probiotic speciesb 乳酸杆菌Lactobacillus 7 0.91(0.70- 1.18) 35.4 双歧杆菌Bifidobacterium 1 1.06(0.71- 1.58) -a 混合种类益生菌Mixed species of probiotics 5 0.96(0.78- 1.18) 0 益生菌剂量b Probiotic doseb ≥中位数(7.5×109 cfu/d)≥Median(7.5×109 cfu/d) 6 0.99(0.81- 1.20) 30.7 <中位数(7.5×109 cfu/d)<Median(7.5×109 cfu/d) 6 0.98(0.76- 1.27) 0 不清楚Unclear 1 0.48(0.23- 1.02) -a 是否合用益生元Prebiotics 是Yes 3 0.90(0.72- 1.13) 0 否No 9 1.00(0.82- 1.23) 4.5 干预疗程Duration of intervention ≥中位数(7个月)≥Median(7 months) 7 0.93(0.79- 1.10) 0 <中位数(7个月)<Median(7 months) 4 1.33(0.89- 2.00) 26.3 不清楚Unclear 1 0.48(0.23- 1.02) -a 随访时间c Follow-up durationc ≥6年≥6 years 6 1.07(0.84- 1.36) 0 <6年<6 years 9 0.86(0.71- 1.03) 0 a:该亚组中仅有1篇研究,因而无法计算I2统计量;b:Wickens的研究有两个干预组,因而将该研究拆分为两部分(Wickens a,Wickens b);c:针对有多个长期随访结果的同一项RCT,将随访时间最长的结果纳入Meta分析,将其他随访时间的结果纳入相应的亚组分析a:there was only 1 study in this subgroup,so I2statistic cannot be calculated;b:Wickens"s study was divided into two parts(Wickens a,Wickens b)as there were two intervention groups;c:when a trial reported results for more than one time period,results from the longest follow-up were included in the main meta-analysis,results from earlier time periods were included in subgroup analyses
本文编号：3441090
【文章来源】：中国医学科学院学报. 2020,42(02)北大核心CSCD
【文章页数】：12 页
【部分图文】：
益生菌预防哮喘相关研究偏倚风险评价
表2 益生菌治疗哮喘相关文献基本特征Table 2 Characteristics of included studies on the role of probiotic supplementation in asthma treatment 纳入研究Included studies 干预人群Intervention populations 干预Intervention 疗程Intervention duration 结局指标Outcome indicators 益生菌组Probiotic group 对照组Control group Giovannini等2007[34] 儿童Children 干酪乳杆菌 DN- 114 001 1×1010 cfu/d、保加利亚乳杆菌 1×109 cfu/d、嗜热链球菌 1×1010 cfu/dLactobacillus casei DN- 114 001 1×1010 cfu/d,lactobacillus bulgaricus 1×109 cfu/d,streptococcus thermophilus 1×1010 cfu/d(n=62) 安慰剂Placebo(n=57) 12个月12 months 哮喘及鼻炎的无症状持续时间、急性发作次数、发作平均持续时间、不良反应、免疫指标等Time free from episodes of asthma and/or rhinitis;cumulative number and duration of episodes;side effects;immunologic parameters Gutkowski等2010[33] 儿童Children 嗜酸乳杆菌、两歧双歧杆菌、德氏乳杆菌保加利亚亚种,共3.2×109 cfu/dLactobacillus acidophilus,bifidobacterium bifidum,lactobacillus delbrueckii subsp. bulgaricus,3.2×109 cfu/d in total(n=22) 安慰剂Placebo(n=24) 3个月3 months 哮喘急性发作次数、支气管扩张剂使用情况、肺功能、不良反应、免疫指标等Asthma exacerbations;bronchodilators usage;lung function;side effects;immunologic parameters Chen等2010[32] 儿童Children 加塞乳酸杆菌A5 4×109 cfu/dLactobacillus gasseri A5 4×109 cfu/d(n=49) 安慰剂Placebo(n=56) 2个月2 months 日间、夜间哮喘症状评分、肺功能、哮喘控制情况、免疫指标等The day and nighttime symptoms of asthma;lung function;asthma control;immunologic parameters Van De Pol等2011[31] 成人Adults 短双歧杆菌M- 16V 1×1010 cfu、短链低聚半乳糖/长链低聚果糖混合物 (7.2∶0.8 g),每日两次Bifidobacterium breve M- 16V 1×1010 cfu,short-chain galacto-oligosaccharides / long-chain fructo-oligosaccharides mixture (7.2∶0.8 g),twice daily(n=14) 安慰剂Placebo(n=15) 1个月1 month 诱导痰嗜酸性粒细胞计数、肺功能、免疫指标、不良反应等Eosinophil counts in sputum;lung function;immunologic parameters;side effects Ahanchian等2016[30] 儿童Children 干酪乳杆菌、鼠李糖乳杆菌、嗜热链球菌、短双歧杆菌、嗜酸乳杆菌、婴儿双歧杆菌、保加利亚乳杆菌,共1×109 cfu/d;低聚果糖Lactobacillus casei,lactobacillus rhamnosus,streptococcus thermophiles,bifidobacterium breve,lactobacillus acidophilus,bifidobacterium infantis,lactobacillus bulgaricus,1×109 cfu/d in total;fructooligosacharide (n=36) 安慰剂Placebo(n=36) 2个月2 months 呼吸道病毒感染次数、沙丁胺醇及泼尼松龙的使用情况、缺课、门诊及住院次数、不良反应等Number of viral respiratory infections;salbutamol and prednisolone usage;school absence;outpatient visits and hospital admission for asthma;side effects Huang等2018[29] 儿童Children 干预组1:副干酪乳杆菌GMNL- 133 (n=38);干预组2:发酵乳杆菌GM- 090 (n=38);干预组3:副干酪乳杆菌GMNL- 133 + 发酵乳杆菌GM- 090 (n=36)Group 1:lactobacillus paracasei GMNL- 133 (n=38);group 2:lactobacillus fermentum GM- 090 (n=38);group 3:lactobacillus paracasei GMNL- 133 + lactobacillus fermentum GM- 090(n=36) 安慰剂Placebo(n=35) 3个月3 months 哮喘严重程度、哮喘控制情况、哮喘患儿生活质量、肺功能、药物使用、免疫指标等Asthma severity;asthma control;pediatric asthma quality of life;lung function;medication use;immunologic parameters图3 益生菌对哮喘的预防作用
图2 益生菌治疗哮喘相关研究偏倚风险评价表3 益生菌对哮喘的预防作用的亚组分析Table 3 Subgroup analyses of the role of probiotic supplementation in asthma prevention 亚组Subgroup 研究数目No. of studies RR(95%CI) I2(%) 研究所处地区Geographical area 欧洲Europe 8 0.95(0.77- 1.16) 20.4 其他Others 4 0.96(0.77- 1.21) 0 干预对象Intervention populations 母亲Mothers 1 3.20(0.34- 30.38) -a 婴儿Infants 5 0.81(0.59- 1.11) 13.3 母亲及婴儿Mothers and infants 6 0.99(0.83- 1.18) 0 婴儿哮喘发生风险Infant asthma risk 高风险人群High risk population 10 0.94(0.81- 1.10) 1.3 一般人群Unselected population 2 1.32(0.54- 3.19) 0 干预时机Timing of intervention 产后Postnatal 5 0.81(0.59- 1.11) 13.3 产前和产后Prenatal and postnatal 7 1.00(0.84- 1.19) 0 益生菌种类b Probiotic speciesb 乳酸杆菌Lactobacillus 7 0.91(0.70- 1.18) 35.4 双歧杆菌Bifidobacterium 1 1.06(0.71- 1.58) -a 混合种类益生菌Mixed species of probiotics 5 0.96(0.78- 1.18) 0 益生菌剂量b Probiotic doseb ≥中位数(7.5×109 cfu/d)≥Median(7.5×109 cfu/d) 6 0.99(0.81- 1.20) 30.7 <中位数(7.5×109 cfu/d)<Median(7.5×109 cfu/d) 6 0.98(0.76- 1.27) 0 不清楚Unclear 1 0.48(0.23- 1.02) -a 是否合用益生元Prebiotics 是Yes 3 0.90(0.72- 1.13) 0 否No 9 1.00(0.82- 1.23) 4.5 干预疗程Duration of intervention ≥中位数(7个月)≥Median(7 months) 7 0.93(0.79- 1.10) 0 <中位数(7个月)<Median(7 months) 4 1.33(0.89- 2.00) 26.3 不清楚Unclear 1 0.48(0.23- 1.02) -a 随访时间c Follow-up durationc ≥6年≥6 years 6 1.07(0.84- 1.36) 0 <6年<6 years 9 0.86(0.71- 1.03) 0 a:该亚组中仅有1篇研究,因而无法计算I2统计量;b:Wickens的研究有两个干预组,因而将该研究拆分为两部分(Wickens a,Wickens b);c:针对有多个长期随访结果的同一项RCT,将随访时间最长的结果纳入Meta分析,将其他随访时间的结果纳入相应的亚组分析a:there was only 1 study in this subgroup,so I2statistic cannot be calculated;b:Wickens"s study was divided into two parts(Wickens a,Wickens b)as there were two intervention groups;c:when a trial reported results for more than one time period,results from the longest follow-up were included in the main meta-analysis,results from earlier time periods were included in subgroup analyses
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