Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
Depress Anxiety. 2018 Oct;35(10):935-945. doi: 10.1002/da.22811. Epub 2018 Jul 11.
The concept "psychobiotics" claims potential beneficial effect of probiotics on anxiety, whereas findings from clinical trials are inconsistent. Thus, a meta-analysis is needed to clarify the effect of probiotics on anxiety.
Randomized controlled trials (RCTs) assessing the effect of probiotics on anxiety were systematically retrieved from online databases and manually screened for references of relevant published literature through September 1, 2017. Standardized mean difference in change from baseline of anxiety rating scales between probiotics groups and placebo groups was selected as the main effect index. Subgroup analyses were conducted with respect to overall health status of the sample, existence of gastrointestinal symptoms, strains of flora, trial duration, and risk of bias assessment. Publication bias was evaluated by funnel plot and Egger's test. The reliability of the result was assessed by leave-one-out sensitivity analysis.
Twelve studies with 1,551 subjects (871 in probiotics group and 680 in control group) were included. All the studies were rated as low or moderate risk of bias. The meta-analysis and subgroup analyses all showed no significant difference between probiotics and placebo in alleviating anxiety symptoms. The Egger's test revealed no evidence of significant publication bias. Sensitivity analysis showed that leaving out one study would result in marginal significance.
The evidence for the efficacy of probiotics in alleviating anxiety, as presented in currently published RCTs, is insufficient. More reliable evidence from clinical trials is needed before a case can be made for promoting the use of probiotics for alleviating anxiety.
“心理益生菌”的概念声称益生菌对焦虑有潜在的有益作用，而临床试验的结果却不一致。因此，需要进行荟萃分析以阐明益生菌对焦虑的影响。
系统地从在线数据库中检索评估益生菌对焦虑影响的随机对照试验（RCT），并通过手动筛选相关已发表文献的参考文献来筛选。选择益生菌组和安慰剂组之间焦虑评分量表的基线变化的标准化均数差作为主要效应指标。针对样本的整体健康状况、存在胃肠道症状、菌群菌株、试验持续时间和偏倚风险评估进行了亚组分析。通过漏斗图和 Egger 检验评估发表偏倚。通过留一法敏感性分析评估结果的可靠性。
纳入了 12 项研究，共 1551 名受试者（益生菌组 871 名，对照组 680 名）。所有研究的偏倚风险均被评为低或中度。荟萃分析和亚组分析均表明，益生菌组和安慰剂组在缓解焦虑症状方面无显著差异。Egger 检验未发现显著发表偏倚的证据。敏感性分析表明，删除一项研究将导致边缘显著。
目前发表的 RCT 中，益生菌缓解焦虑的疗效证据不足。需要更多来自临床试验的可靠证据，才能证明推广使用益生菌来缓解焦虑是合理的。
