乳酸菌在克罗恩病维持治疗中的效果和不良反应-随机对照研究的系统评价

目的 评价乳酸菌在克罗恩病维持治疗中的效果和不良反应.方法 检索MEDLINE,EMBASE,the Cochrane Controlled Trials Register,OVID,BIOSIS,从电子数据库中提取所有对比研究乳酸菌素和安慰剂对克罗恩病维持治疗的随机对照试验,使用Rev Man4.2.10软件统计分析,同时做亚组分析和敏感性分析.结果 6项随机对照试验中共有359例患者符合入选标准.通过荟萃分析,对比乳酸菌和安慰剂维持治疗,克罗恩病的临床复发率相对危险度(relative risk,RR)为1.15(95%CI为0.90～1.48).亚组分析表明:对比乳酸菌和安慰剂维持治疗,成人临床复发率RR为0.99(95%CI=0.76～1.29),儿童为1.85(95%CI=1.00～3.41),LGG(Lactobacillus rhamnosus strain GG,LGG)为1.68(95%CI=1.07～2.64),LA1(Lactobacillus johnsonii,LAl)为0.91(95%CI=0.68～1.23).不良反应发生的RR为0.83(95%CI=0.61～1.12).结论 与安慰剂相比,使用乳酸菌作为克罗恩病维持治疗对减少复发率无效.

Effect and Adverse Events of Lactobacilli in Maintenance Therapy for Crohn's Disease:Meta-analysis of Randomized Controlled Trials

Objective To evaluate the efficacy and adverse events of lactobacilli in maintenance therapy for Crohn's disease.Methods We searched MEDLINE,EMBASE,the Cochrane Controlled Trials Register,OVID and BIOSIS.All randomized trials comparing lactobacilli with placebo in maintenance therapy for Crohn's disease were included from electronic databases.Statistical analysis was performed by meta-analysis using Review Manager 4.2.10.Sub-analysis and sensitivity analysis were also performed.Results Six randomized controlled trials with a total of 359 participants met the inclusion criteria.From the meta-analysis,the relative risk(RR) of clinical relapse rate was 1.15(95% CI=0.90~1.48) comparing lactobacilli with placebo and RR of endoscopic relapse rate was 1.31(95% CI=0.57~3.00).Subgroup analysis showed RR for clinical relapse rates of lactobacilli vs.placebo were 0.99(95% CI=0.76~1.29) in adults,1.85(95% CI=1.00~3.41) in children,1.68(95% CI=1.07~2.64) in lactobacillus rhamnosus strain GG and 0.91(95% CI=0.68~1.23) in lactobacillus johnsonii,respectively.The pooled RR of adverse events was 0.83(95% CI=0.61~1.12).Conclusion Our meta-analysis suggests that compared with placebo,administration of lactobacillus as maintenance therapy for Crohn's disease is ineffective in reducing the incidence of relapse.