State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):9-16. doi: 10.1016/j.hbpd.2018.01.005. Epub 2018 Feb 2.
Minimal hepatic encephalopathy (MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE.
Seven electronic databases were searched for relevant randomized controlled trials (RCTs) published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated.
A total of 14 RCTs (combined n = 1132) were included in the meta-analysis. When probiotics were compared to placebo or no treatment, probiotics were more likely to reduce values in the number connection test (NCT; week 4: MD = -30.25, 95% CI: -49.85 to -10.66), improve MHE (week 4: OR = 0.18, 95% CI: 0.07 to 0.47; week 12: OR = 0.15, 95% CI: 0.07 to 0.32), and prevent overt HE progression (week 4: OR = 0.22, 95% CI: 0.07 to 0.67) in patients with liver cirrhosis. When probiotics was compared to lactulose, probiotics tended to reduce serum ammonia levels (week 4: MD = -0.33 µmol/L, 95% CI: -5.39 to 4.74; week 8: MD = 6.22 µmol/L, 95% CI: -24.04 to 36.48), decrease NCT (week 8: MD = 3.93, 95% CI: -0.72 to 8.58), improve MHE (week 4: OR = 0.93, 95% CI: 0.45 to 1.91; week 12: OR = 0.73, 95% CI: 0.35 to 1.51) and prevent the development of overt HE (week 4: OR = 0.96, 95% CI: 0.17 to 5.44; week 12: OR = 2.7, 95% CI: 0.50 to 14.64) in patients with liver cirrhosis. However, lactulose appears to be more effective in reducing NCT values as compared to probiotics (week 4: MD = 6.7, 95% CI: 0.58 to 12.82).
Probiotics can decrease serum ammonia and endotoxin levels, improve MHE, and prevent overt HE development in patients with liver cirrhosis.
轻微型肝性脑病（MHE）是肝性脑病的早期和可逆转形式。关于益生菌治疗的文献报道并不一致。本荟萃分析旨在验证益生菌在治疗 MHE 肝硬化患者中的作用。
检索了截至 2015 年 7 月发表的相关随机对照试验（RCT）的七个电子数据库。评估了益生菌对血清氨、内毒素和 MHE 的影响。
共纳入 14 项 RCT（合并 n=1132）进行荟萃分析。与安慰剂或不治疗相比，益生菌更有可能降低连线测试（NCT）的数值（第 4 周：MD=-30.25，95%CI：-49.85 至-10.66），改善 MHE（第 4 周：OR=0.18，95%CI：0.07 至 0.47；第 12 周：OR=0.15，95%CI：0.07 至 0.32），并预防显性肝性脑病进展（第 4 周：OR=0.22，95%CI：0.07 至 0.67）。与乳果糖相比，益生菌更倾向于降低血清氨水平（第 4 周：MD=-0.33 µmol/L，95%CI：-5.39 至 4.74；第 8 周：MD=6.22 µmol/L，95%CI：-24.04 至 36.48），减少 NCT（第 8 周：MD=3.93，95%CI：-0.72 至 8.58），改善 MHE（第 4 周：OR=0.93，95%CI：0.45 至 1.91；第 12 周：OR=0.73，95%CI：0.35 至 1.51），并预防显性肝性脑病的发生（第 4 周：OR=0.96，95%CI：0.17 至 5.44；第 12 周：OR=2.7，95%CI：0.50 至 14.64）。然而，与益生菌相比，乳果糖似乎更能有效降低 NCT 值（第 4 周：MD=6.7，95%CI：0.58 至 12.82）。
益生菌可降低肝硬化患者血清氨和内毒素水平，改善 MHE，预防显性肝性脑病的发生。
