Guthmann F, Kluthe C, Bührer C
Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Germany.
Klin Padiatr. 2010 Sep;222(5):284-90. doi: 10.1055/s-0030-1254113. Epub 2010 Jul 19.
Several randomized controlled trials (RCTs) have investigated the prophylactic use of probiotics in preterm infants aimed at reducing the rate of necrotising enterocolitis (NEC). There are 4 meta-analyses on this subject. 2 more RCTs have been published since these meta-analyses were completed. Each meta-analysis, as well as the 2 recent RCTs, document reduced rates of NEC and mortality with the use of prophylactic probiotics. We calculated meta-analyses based on 3 approaches: A - RCTs common to all meta-analyses, B - RCTs ever accounted for in a meta-analysis but not common to all, and C - the 2 recent RCTs. The 3 subgroups yield similar results, with an overall reduction in the relative risk (RR) of NEC (Bell > or =2) to 0.35 (95% CI 0.23-0.55) and of mortality to 0.41 (0.28-0.60). NEC rates and mortalities in the dominant RCTs are in the range reported from North American and European networks. Best results appear to be achieved with probiotics based on 2 or more probiotic species and/or with a combination of Bifidusbacterium spp. and Lactobacillus acidophilus. No unwanted side effects have been reported among 1 117 infants randomized to receive probiotics. We conclude that probiotics are safe and beneficial in preterm infants at risk for NEC.
多项随机对照试验（RCT）研究了益生菌在早产儿中的预防性使用，旨在降低坏死性小肠结肠炎（NEC）的发生率。关于这一主题有4项荟萃分析。自这些荟萃分析完成以来，又发表了2项RCT。每项荟萃分析以及最近的2项RCT都表明，使用预防性益生菌可降低NEC发生率和死亡率。我们基于3种方法进行了荟萃分析：A - 所有荟萃分析共有的RCT，B - 曾在荟萃分析中出现但并非所有荟萃分析都共有的RCT，以及C - 最近的2项RCT。这3个亚组得出了相似的结果，NEC的相对风险（RR）（Bell≥2）总体降低至０.35（95%CI 0.23 - 0.55），死亡率降低至0.41（0.28 - 0.60）。主要RCT中的NEC发生率和死亡率处于北美和欧洲研究网络报告的范围内。基于2种或更多种益生菌和/或双歧杆菌属与嗜酸乳杆菌组合的益生菌似乎能取得最佳效果。在1117名随机接受益生菌的婴儿中未报告有不良副作用。我们得出结论，益生菌对有NEC风险的早产儿是安全且有益的。
