Butterworth Andrew D, Thomas Adrian G, Akobeng Anthony Kwaku
Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester, UK, M9 7AA.
Cochrane Database Syst Rev. 2008 Jul 16;2008(3):CD006634. doi: 10.1002/14651858.CD006634.pub2.
Crohn's disease has a high morbidity and there is no known cure. Current treatments have multiple side effects and an effective treatment with minimal side effects is desired. Probiotics have been proposed as such a treatment but their efficacy is undetermined. There is some evidence that probiotics are effective in other conditions affecting the gastrointestinal tract and they are popular with patients. They are thought to work through competitive action with commensal and pathogenic flora, influencing the immune response.
To determine if there is any evidence for the efficacy of probiotics for the induction of remission in Crohn's disease.
The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2007), MEDLINE (1966 to 2007), Excerpta Medica/EMBASE (1974 to 2007), CINAHL (1982-2007) and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched. Manufacturers of probiotics were also contacted to identify any unpublished trials. References of trials were also searched for any additional trials.
Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention for the induction of remission in Crohn's disease were eligible for inclusion.
Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical remission. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes.
One small study (n = 11) met the inclusion criteria and was included in the review. There were some methodological concerns with this study. Four of 5 patients in the probiotic group achieved remission compared to 5 of 6 in the placebo group (OR 0.80; 95% CI 0.04 to 17.20).
AUTHORS' CONCLUSIONS: There is insufficient evidence to make any conclusions about the efficacy of probiotics for induction of remission in Crohn's disease. There is a lack of well designed RCTs in this area and further research is needed.
克罗恩病发病率高且尚无治愈方法。目前的治疗有多种副作用，因此需要一种副作用最小的有效治疗方法。益生菌已被提议作为这样一种治疗方法，但其疗效尚未确定。有一些证据表明益生菌在影响胃肠道的其他病症中有效，并且它们受到患者的欢迎。它们被认为是通过与共生菌和致病菌的竞争作用来发挥作用，从而影响免疫反应。
确定是否有证据表明益生菌对诱导克罗恩病缓解有效。
检索了Cochrane对照试验中心注册库（CENTRAL）（2007年第1期）、MEDLINE（1966年至2007年）、医学文摘/EMBASE（1974年至2007年）、CINAHL（1982 - 2007年）以及Cochrane炎症性肠病和功能性肠病小组专门试验注册库。还联系了益生菌制造商以确定任何未发表的试验。还检索了试验的参考文献以查找任何其他试验。
比较益生菌与安慰剂或任何其他干预措施用于诱导克罗恩病缓解的随机对照试验（RCT）符合纳入标准。
两名作者独立进行数据提取和纳入研究的方法学质量评估。主要结局指标是临床缓解的发生情况。对二分法结局计算比值比和95%置信区间。
一项小型研究（n = 11）符合纳入标准并被纳入综述。该研究存在一些方法学问题。益生菌组5名患者中有4名实现缓解，而安慰剂组6名患者中有5名实现缓解（OR 0.80；95% CI 0.04至17.20）。
没有足够证据就益生菌对诱导克罗恩病缓解的疗效得出任何结论。该领域缺乏设计良好的随机对照试验，需要进一步研究。
