*Department of Gastroenterology, Renji Hospital, Shanghai Jiao-Tong University, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China; †Department of Medicine, University of Chicago, Chicago, Illinois; and ‡Committee on Immunology, Department of Pathology, University of Chicago, Chicago, Illinois.
Inflamm Bowel Dis. 2014 Jan;20(1):21-35. doi: 10.1097/01.MIB.0000437495.30052.be.
Whether probiotics are beneficial at all stages of treatment in inflammatory bowel disease or superior to placebo remains controversial.
Two reviewers independently selected randomized controlled trials comparing probiotics with controls in inflammatory bowel disease and extracted data related to remission/response rates, relapse rates, and adverse events. Subanalyses were also performed.
Twenty-three randomized controlled trials with a total of 1763 participants met the inclusion criteria. From the meta-analysis, probiotics significantly increase the remission rates in patients with active ulcerative colitis (UC) (P = 0.01, risk ratio [RR] = 1.51). The remission rates were significantly higher in patients with active UC treated with probiotics than placebo (P < 0.0001, RR = 1.80). Unfortunately, subgroup analysis found that only VSL#3 significantly increased the remission rates compared with controls in patients with active UC (P = 0.004, RR = 1.74). Interestingly, VSL#3 (P < 0.00001, RR = 0.18) also significantly reduced the clinical relapse rates for maintaining remission in patients with pouchitis. No significantly different adverse events were detected between probiotics and controls in the treatment of UC (P = 0.94, RR = 0.99) or CD (P = 0.33, RR = 0.87).
Administration of probiotics results in additional benefit in inducing remission of patients with UC. VSL#3 are beneficial for maintaining remission in patients with pouchitis. And, probiotics can provide the similar effect as 5-aminosalicylic acid on maintaining remission of UC, although no additional adverse events presented.
益生菌在炎症性肠病的治疗各个阶段是否有益，或者是否优于安慰剂，仍存在争议。
两位审查员独立选择比较益生菌与炎症性肠病对照的随机对照试验，并提取与缓解/反应率、复发率和不良事件相关的数据。还进行了亚组分析。
23 项随机对照试验共纳入 1763 名参与者符合纳入标准。荟萃分析显示，益生菌可显著提高活动期溃疡性结肠炎（UC）患者的缓解率（P = 0.01，风险比 [RR] = 1.51）。与安慰剂相比，活动期 UC 患者接受益生菌治疗的缓解率显著更高（P < 0.0001，RR = 1.80）。不幸的是，亚组分析发现，只有 VSL#3 与对照组相比可显著提高活动期 UC 患者的缓解率（P = 0.004，RR = 1.74）。有趣的是，VSL#3 还显著降低了 pouchitis 患者维持缓解的临床复发率（P < 0.00001，RR = 0.18）。在 UC（P = 0.94，RR = 0.99）或 CD（P = 0.33，RR = 0.87）的治疗中，益生菌与对照组之间未检测到显著不同的不良事件。
益生菌治疗可使 UC 患者获得额外的缓解获益。VSL#3 对 pouchitis 患者维持缓解有益。而且，益生菌在维持 UC 缓解方面的效果与 5-氨基水杨酸相似，尽管未出现额外的不良事件。
