Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.
Dig Dis Sci. 2019 Feb;64(2):469-479. doi: 10.1007/s10620-018-5243-9. Epub 2018 Aug 11.
BACKGROUND/OBJECTIVES: We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients.
A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137.
Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2 months after treatment) with standardized mean difference (SMD) of - 0.42 (95% CI - 0.68 to - 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of - 0.37 (95% CI - 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of - 0.32 (95% CI - 0.92 to 0.28, p = 0.29) and 0.16 (95% CI - 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of - 0.61 (95% CI - 1.16 to - 0.07, p = 0.03) and - 1.04 (95% CI - 1.70 to - 0.38, p = 0.002), respectively.
Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.
背景/目的：我们进行了这项系统评价和荟萃分析，以评估益生菌对终末期肾病（ESRD）患者炎症、尿毒症毒素和胃肠道（GI）症状的影响。
利用 MEDLINE、EMBASE 和 Cochrane 数据库从成立到 2017 年 10 月进行文献检索。我们纳入了评估益生菌对透析 ESRD 患者炎症标志物、蛋白结合尿毒症毒素（PBUT）和 GI 症状影响的研究。从单个研究中提取效应估计值，并利用 DerSimonian 和 Laird 的随机效应、通用倒数方差法进行合并。本荟萃分析的方案已在 PROSPERO 中注册；编号 CRD42017082137。
纳入了 7 项临床试验，共 178 名 ESRD 患者。与基线相比，益生菌治疗后（治疗后≥2 个月）血清 C 反应蛋白（CRP）水平显著降低，标准化均数差（SMD）为-0.42（95%CI-0.68 至-0.16，p=0.002）。与对照组相比，接受益生菌治疗的患者 CRP 水平也有显著降低，SMD 为-0.37（95%CI-0.72 至 0.03，p=0.04）。然而，血清 TNF-α或白蛋白水平没有显著变化，SMD 分别为-0.32（95%CI-0.92 至 0.28，p=0.29）和 0.16（95%CI-0.20 至 0.53，p=0.39）。益生菌治疗后，蛋白结合尿毒症毒素（PBUT）也显著降低，总体胃肠道（GI）症状得到改善（GI 症状评分降低），SMD 分别为-0.61（95%CI-1.16 至-0.07，p=0.03）和-1.04（95%CI-1.70 至-0.38，p=0.002）。
我们的研究表明益生菌对 ESRD 患者的炎症、尿毒症毒素和胃肠道（GI）症状有潜在的有益作用。需要进行大规模的临床研究来评估其对其他重要临床结局（包括患者死亡率）的益处。
