McFarland Lynne V
Department of Health Services Research and Development, Veterans Administration Puget Sound Health Care System, Seattle, Washington 98101, USA.
Am J Gastroenterol. 2006 Apr;101(4):812-22. doi: 10.1111/j.1572-0241.2006.00465.x.
Antibiotic-associated diarrhea (AAD) is a common complication of most antibiotics and Clostridium difficile disease (CDD), which also is incited by antibiotics, is a leading cause of nosocomial outbreaks of diarrhea and colitis. The use of probiotics for these two related diseases remains controversial.
To compare the efficacy of probiotics for the prevention of AAD and the treatment of CDD based on the published randomized, controlled clinical trials.
PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and Cochrane Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language. Secondary searches of reference lists, authors, reviews, commentaries, associated diseases, books, and meeting abstracts.
Trials were included in which specific probiotics given to either prevent or treat the diseases of interest. Trials were required to be randomized, controlled, blinded efficacy trials in humans published in peer-reviewed journals. Trials that were excluded were pre-clinical, safety, Phase 1 studies in volunteers, reviews, duplicate reports, trials of unspecified probiotics, trials of prebiotics, not the disease being studied, or inconsistent outcome measures. Thirty-one of 180 screened studies (totally 3,164 subjects) met the inclusion and exclusion criteria.
One reviewer identified studies and abstracted data on sample size, population characteristics, treatments, and outcomes.
From 25 randomized controlled trials (RCTs), probiotics significantly reduced the relative risk of AAD (RR = 0.43, 95% CI 0.31, 0.58, p < 0.001). From six randomized trials, probiotics had significant efficacy for CDD (RR = 0.59, 95% CI 0.41, 0.85, p = 0.005).
A variety of different types of probiotics show promise as effective therapies for these two diseases. Using meta-analyses, three types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, and probiotic mixtures) significantly reduced the development of antibiotic-associated diarrhea. Only S. boulardii was effective for CDD.
抗生素相关性腹泻（AAD）是大多数抗生素常见的并发症，而同样由抗生素引发的艰难梭菌病（CDD）是医院内腹泻和结肠炎暴发的主要原因。益生菌用于这两种相关疾病的治疗仍存在争议。
基于已发表的随机对照临床试验，比较益生菌预防AAD和治疗CDD的疗效。
检索了1977年至2005年期间的PubMed、Medline、谷歌学术、美国国立卫生研究院临床试验注册库、metaRegister以及Cochrane对照试验中心注册库，检索不受语言限制。对参考文献列表、作者、综述、评论、相关疾病、书籍及会议摘要进行二次检索。
纳入给予特定益生菌预防或治疗相关疾病的试验。要求试验为发表在同行评审期刊上的针对人类的随机、对照、双盲疗效试验。排除的试验包括临床前试验、安全性试验、志愿者的1期研究、综述、重复报告、未明确益生菌的试验、益生元试验、非所研究疾病的试验或结局指标不一致的试验。在筛选的180项研究（共3164名受试者）中，有31项符合纳入和排除标准。
一名评审员确定研究并提取关于样本量、人群特征、治疗方法和结局的数据。
从25项随机对照试验（RCT）中得出，益生菌显著降低了AAD的相对风险（RR = 0.43，95%CI 0.31，0.58，p < 0.001）。从6项随机试验中得出，益生菌对CDD有显著疗效（RR = 0.59，95%CI 0.41，0.85，p = 0.005）。
多种不同类型的益生菌有望成为这两种疾病的有效治疗方法。通过荟萃分析，三种类型的益生菌（布拉氏酵母菌、鼠李糖乳杆菌GG和益生菌混合物）显著降低了抗生素相关性腹泻的发生率。只有布拉氏酵母菌对CDD有效。
