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益生菌对轻微型肝性脑病患者显性肝性脑病发生率影响的Meta分析

姚俞昊 张嘉鑫 夏潇 朱顺 李小科 叶永安

引用本文:
Citation:

益生菌对轻微型肝性脑病患者显性肝性脑病发生率影响的Meta分析

DOI: 10.3969/j.issn.1001-5256.2022.11.013
基金项目: 

国家自然科学基金项目 82174341;

国家中医药管理局科研基金项目 JDZX2015300;

北京中医药大学新教师启动基金项目 2022-JYB-XJSJJ-050

利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:叶永安、李小科对研究思路、设计有关键贡献;姚俞昊起草了文章;姚俞昊、夏潇、朱顺参与了研究数据的获取分析解释过程;李小科、张嘉鑫对文章关键内容进行了修改。
详细信息
    通信作者:

    李小科,lixiaoke@vip.163.com

    叶永安,yeyongan@vip.163.com

Effect of probiotics in preventing overt hepatic encephalopathy in patients with minimal hepatic encephalopathy: A Meta-analysis

Research funding: 

National Natural Science Foundation of China 82174341;

National Administration of Traditional Chinese Medicine Research Fund JDZX2015300;

Beijing University of Traditional Chinese Medicine Start-up Fund 2022-JYB-XJSJJ-050

More Information
  • 摘要:   目的  评价使用益生菌干预对轻微型肝性脑病患者显性肝性脑病发生率的影响。  方法  本研究根据PRISMA指南完成,PROSPERO注册号为CRD42022303995。检索PubMed、Web of Science、Cochrane Library、知网、万方数据库,收集建库至2021年11月有关益生菌干预治疗轻微型肝性脑病的研究。用RevMan 5.4进行Meta分析,不能合并的数据采用描述性分析。选择危险比(RR)和95%CI作为汇总指标。  结果  共纳入6篇文献,均为随机对照研究,共404例轻微型肝性脑病患者。结果表明益生菌干预可使轻微型肝性脑病患者显性肝性脑病的发生率降低54%(RR=0.46,95%CI:0.26~0.81,P=0.007),并且能增加轻微型肝性脑病患者疾病的逆转率(RR=4.94,95%CI:2.82~8.66,P<0.000 01)。  结论  益生菌能够降低轻微型肝性脑病患者显性肝性脑病的发生率,增加轻微型肝性脑病的逆转率,对轻微型肝性脑病患者预防显性肝性脑病的发生具有积极意义,为益生菌治疗轻微型肝性脑病提供了新的证据。

     

  • 图  1  文献筛选流程

    Figure  1.  Flowchart of selection of trials

    图  2  质量评价结果

    Figure  2.  Methodological quality of the included trials

    图  3  益生菌与MHE患者OHE发生率的Meta分析结果

    Figure  3.  Incidence of OHE with the treatment of probiotics or controlled

    图  4  益生菌与MHE患者逆转率的Meta分析结果

    Figure  4.  Reversal of MHE with the treatment of probiotics or controlled

    表  1  纳入文献的基本特征

    Table  1.   Characteristics of the included trials

    纳入研究及时间 干预措施 研究时间 结局指标
    罗兰[19](2019) 干预组:枯草杆菌二联活菌肠溶胶囊250 mg/粒,2粒,3次/d
    对照组:肝硬化常规治疗
    4周 ①③④⑤⑧⑨ B11
    Bajaj等[14](2014) 干预组:乳酸菌(>5×1010 CFU/g)
    对照组:安慰剂
    8周 ①③④⑥⑦⑩ B11
    Vlachogiannakos等[18](2014) 干预组:乳酸菌
    对照组:安慰剂
    12周 ①②③④
    Lunia等[15](2013) 干预组:益生菌(1.1×1011 CFU/粒) 1粒,3次/d
    对照组:无治疗
    12周 ①②③④
    Mittal等[17](2011) 干预组:益生菌(1.1×1011 CFU)次/d
    对照组:肝硬化常规治疗
    12周 ①②③④⑦
    Bajaj等[13](2008) 干预组:酸奶12盎司/d
    对照组:无治疗
    8周 ①②③④⑥⑦⑧⑨
    纳入研究及时间 地区 研究类型 研究人数(E∶C) MHE诊断指标
    罗兰[19](2019) 中国 RCT 109(56∶53) NCT、DST
    Bajaj等[14](2014) 美国 RCT 37(18∶19) NCT、DST、BDT
    Vlachogiannakos等[18](2014) 希腊 RCT 72(37∶35) NCT、BEAP
    Lunia等[15](2013) 印度 RCT 81(42∶39) PHES≤5
    Mittal等[17](2011) 印度 RCT 80(40∶40) NCT、FCT
    Bajaj等[13](2008) 美国 RCT 25(17∶8) NCT、BDT、DST
    注:E,干预组;C,对照组;NCT,数字连接测试;DST,数字符号试验;BDT,block design test;PHES,HE智力测试评分;BEAP,brainstem auditory evoked potentials;FCT,figure connection test。结局指标包括①OHE发生率;②MHE逆转率;③神经心理学测试;④血氨;⑤ALT、AST;⑥炎性指标;⑦生活质量;⑧Child-Pugh评分;⑨MELD评分;⑩肠道菌群;B11不良事件发生。
    下载: 导出CSV

    表  2  OHE发生率的亚组分析

    Table  2.   Summary of subgroup analysis of OHE incidence

    亚组 研究数目 RR(95%CI) 异质性 P
    P I2
    地域 0.36
      东方[15, 17, 19] 3 0.55(0.28~1.05) 0.55 0
      西方[13-14, 18] 3 0.29(0.09~0.92) 0.76 0
    益生菌使用时间 0.75
      ≤8周[13-14, 19] 3 0.56(0.16~1.94) 0.82 0
      8~12周[15, 17-18] 3 0.44(0.23~0.83) 0.48 0
    下载: 导出CSV
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  • 收稿日期:  2022-04-06
  • 录用日期:  2022-05-10
  • 出版日期:  2022-11-20
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