Rossi Megan, Klein Kerenaftali, Johnson David W, Campbell Katrina L
School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia ; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia ; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia.
Int J Nephrol. 2012;2012:673631. doi: 10.1155/2012/673631. Epub 2012 Dec 19.
Objective. This paper assessed the effectiveness of pre-, pro-, and synbiotics on reducing two protein-bound uremic toxins, p-cresyl sulphate (PCS) and indoxyl sulphate (IS). Methods. English language studies reporting serum, urinary, or fecal PCS and/or IS (or their precursors) following pre-, pro-, or synbiotic interventions (>1 day) in human adults were included. Population estimates of differences in the outcomes between the pre- and the postintervention were estimated for subgroups of studies using four meta-analyses. Quality was determined using the GRADE approach. Results. 19 studies met the inclusion criteria, 14 in healthy adults and five in haemodialysis patients. Eight studies investigated prebiotics, six probiotics, one synbiotics, one both pre- and probiotics, and three studies trialled all three interventions. The quality of the studies ranged from moderate to very low. 12 studies were included in the meta-analyses with all four meta-analyses reporting statistically significant reductions in IS and PCS with pre- and probiotic therapy. Conclusion. There is a limited but supportive evidence for the effectiveness of pre- and probiotics on reducing PCS and IS in the chronic kidney disease population. Further studies are needed to provide more definitive findings before routine clinical use can be recommended.
目的。本文评估了益生元、益生菌和合生元对降低两种蛋白结合尿毒症毒素——对甲酚硫酸盐（PCS）和吲哚硫酸盐（IS）的效果。方法。纳入英文研究，这些研究报告了成年人类在接受益生元、益生菌或合生元干预（超过1天）后血清、尿液或粪便中的PCS和/或IS（或其前体）情况。使用四项荟萃分析对研究亚组干预前后结果的差异进行总体估计。采用GRADE方法确定质量。结果。19项研究符合纳入标准，其中14项针对健康成年人，5项针对血液透析患者。8项研究调查了益生元，6项研究调查了益生菌，1项研究调查了合生元，1项研究同时调查了益生元和益生菌，3项研究对所有三种干预措施进行了试验。研究质量从中度到极低不等。12项研究纳入荟萃分析，所有四项荟萃分析均报告益生元和益生菌疗法可使IS和PCS有统计学意义的降低。结论。关于益生元和益生菌在慢性肾病患者中降低PCS和IS的有效性，证据有限但具有支持性。在能够推荐常规临床使用之前，需要进一步研究以提供更明确的结果。
