Viramontes Hörner Daniela, Avery Amanda, Stow Ruth
Division of Nutritional Sciences, University of Nottingham, Leicestershire, UK.
J Clin Gastroenterol. 2017 Apr;51(4):312-323. doi: 10.1097/MCG.0000000000000789.
Alterations in the levels of intestinal microbiota, endotoxemia, and inflammation are novel areas of interest in the pathogenesis of hepatic encephalopathy (HE). Probiotics and symbiotics are a promising treatment option for HE due to possible beneficial effects in modulating gut microflora and might be better tolerated and more cost-effective than the traditional treatment with lactulose, rifaximin or L-ornithine-L-aspartate. A systematic search of the electronic databases PubMed, ISI Web of Science, EMBASE, and Cochrane Library was conducted for randomized controlled clinical trials in adult patients with cirrhosis, evaluating the effect of probiotics and symbiotics in changes on intestinal microflora, reduction of endotoxemia, inflammation, and ammonia, reversal of minimal hepatic encephalopathy (MHE), prevention of overt hepatic encephalopathy (OHE), and improvement of quality of life. Nineteen trials met the inclusion criteria. Probiotics and symbiotics increased beneficial microflora and decreased pathogenic bacteria and endotoxemia compared with placebo/no treatment, but no effect was observed on inflammation. Probiotics significantly reversed MHE [risk ratio, 1.53; 95% confidence interval (CI): 1.14, 2.05; P=0.005] and reduced OHE development (risk ratio, 0.62; 95% CI: 0.48, 0.80; P=0.0002) compared with placebo/no treatment. Symbiotics significantly decreased ammonia levels compared with placebo (15.24; 95% CI: -26.01, -4.47; P=0.006). Probiotics did not show any additional benefit on reversal of MHE and prevention of OHE development when compared with lactulose, rifaximin, and L-ornithine-L-aspartate. Only 5 trials considered tolerance with minimal side effects reported. Although further research is warranted, probiotics and symbiotics should be considered as an alternative therapy for the treatment and management of HE given the results reported in this systematic review.
肠道微生物群水平、内毒素血症和炎症的改变是肝性脑病（HE）发病机制中新兴的研究领域。由于益生菌和合生元在调节肠道微生物群方面可能具有有益作用，因此是治疗HE的一种有前景的选择，并且可能比传统的乳果糖、利福昔明或L-鸟氨酸-L-天冬氨酸治疗耐受性更好、成本效益更高。对电子数据库PubMed、ISI Web of Science、EMBASE和Cochrane图书馆进行了系统检索，以查找针对成年肝硬化患者的随机对照临床试验，评估益生菌和合生元对肠道微生物群变化、内毒素血症、炎症和氨的减少、轻微肝性脑病（MHE）的逆转、显性肝性脑病（OHE）的预防以及生活质量改善的影响。19项试验符合纳入标准。与安慰剂/未治疗相比，益生菌和合生元增加了有益微生物群，减少了病原菌和内毒素血症，但未观察到对炎症有影响。与安慰剂/未治疗相比，益生菌显著逆转了MHE[风险比，1.53；95%置信区间（CI）：1.14，2.05；P = 0.005]并降低了OHE的发生（风险比，0.62；95%CI：0.48，0.80；P = 0.0002）。与安慰剂相比，合生元显著降低了氨水平（15.24；95%CI：-26.01，-4.47；P = 0.006）。与乳果糖、利福昔明和L-鸟氨酸-L-天冬氨酸相比，益生菌在逆转MHE和预防OHE发生方面未显示出任何额外益处。仅5项试验考虑了耐受性且报告副作用极小。尽管有必要进行进一步研究，但鉴于本系统评价报告的结果，益生菌和合生元应被视为治疗和管理HE的替代疗法。
