Departments of Surgical Medical Gastroenterology, Hvidovre University Hospital Department of Internal Medicine, Copenhagen University Hospital, Gentofte, Denmark.
Hepatol Res. 2012 Oct;42(10):1008-15. doi: 10.1111/j.1872-034X.2012.01015.x. Epub 2012 Apr 30.
The objective of this systematic review and meta-analysis was to assess the efficacy of probiotics and synbiotics in patients with hepatic encephalopathy.
Eligible trials were identified by searching electronic databases including MEDLINE, the Cochrane Library, Science Citation Index and Embase, abstract proceedings, reference lists and ongoing trial registers until 13 October 2010. We included randomized controlled trials comparing probiotics and synbiotics with no intervention, placebo or lactulose in patients with hepatic encephalopathy. The primary outcome measure was improvement in hepatic encephalopathy. RESULTS were expressed as risk rates (RR) with confidence intervals (CI) and intertrial heterogeneity as I(2) .
Seven trials with a total of 393 patients were analyzed. Compared to placebo or lactulose, treatment with probiotics or synbiotics significantly improved hepatic encephalopathy (RR = 1.40, 95% CI = 1.05-1.86, I(2) = 5%). Probiotics decreased arterial ammonia (weighted mean difference 15.95; 95% CI = 26.72-3.28; I(2) = 68%), but not venous ammonia (weighted mean difference 5.23; 95% CI = 21.77-11.30; I(2) = 89%). Treatment with probiotics or synbiotics did not significantly affect the psychometric tests. Overall adverse events were reported in four trials with no difference between probiotics and placebo groups (RR = 0.32, 95% CI = 0.04-2.57; I(2) = 59%). Regression analysis showed evidence of small-study effects.
The present meta-analysis suggests that probiotics may be an effective treatment of hepatic encephalopathy, though rigorous evaluation in standardized, randomized, clinical trial with clinically relevant outcomes is still needed.
本系统评价和荟萃分析的目的是评估益生菌和合生剂在肝性脑病患者中的疗效。
通过检索 MEDLINE、Cochrane 图书馆、科学引文索引和 Embase 等电子数据库，以及摘要会议、参考文献列表和正在进行的试验登记处，直到 2010 年 10 月 13 日，确定了符合条件的试验。我们纳入了将益生菌和合生剂与无干预、安慰剂或乳果糖比较治疗肝性脑病患者的随机对照试验。主要观察指标是肝性脑病的改善。结果以风险比（RR）及其置信区间（CI）表示，并以 I(2) 表示试验间异质性。
分析了 7 项共 393 例患者的试验。与安慰剂或乳果糖相比，益生菌或合生剂治疗可显著改善肝性脑病（RR=1.40，95%CI=1.05-1.86，I(2)=5%）。益生菌降低了动脉血氨（加权均数差 15.95；95%CI=26.72-3.28；I(2)=68%），但不降低静脉血氨（加权均数差 5.23；95%CI=21.77-11.30；I(2)=89%）。益生菌或合生剂治疗对心理测试无显著影响。四项试验报告了总体不良事件，但益生菌与安慰剂组之间无差异（RR=0.32，95%CI=0.04-2.57；I(2)=59%）。回归分析显示存在小样本研究效应。
本荟萃分析表明，益生菌可能是肝性脑病的有效治疗方法，但仍需要采用标准化、随机、具有临床相关结局的临床试验进行严格评估。
