Department of Prevention Medicine, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China.
Department of Basic Medicine, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China.
Microb Pathog. 2020 Jan;138:103794. doi: 10.1016/j.micpath.2019.103794. Epub 2019 Oct 28.
Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in premature infants. In order to evaluate the efficacy of probiotics in the prevention of stage II-III NEC, we performed a meta-analysis of clinical studies.
We searched in PubMed, Medline and Embase from 1 January 1990 to 16 January 2018. Heterogeneity was examined by Q-test. Publication bias was evaluated by funnel plot and Egger's regression test.
30 articles were identified meeting the inclusion criteria. Data showed that probiotics supplement could significantly reduce the risk of stage II-III NEC (RR = 0.51, 95% CI, 0.38 to 0.67, P < 0.001) and death rate (RR = 0.69, 95% CI, 0.55 to 0.87, P = 0.002). The mixed probiotics and lactobacillus could reduce the risk of stage II-III NEC (for mixed probiotics, RR = 0.39, 95% CI, 0.26 to 0.57; for lactobacillus, RR = 0.53, 95% CI, 0.36 to 0.78), while bifidobacterium or saccharomyces did not have such effect. The results also indicated that only the mixed probiotics could reduce the risk of deaths (RR = 0.52, 95%CI, 0.34 to 0.80). Subgroup analysis for mortality revealed that probiotics had significant effect in Asian region (RR = 0.54, 95% CI, 0.37 to 0.80, P = 0.002) but not in non-Asian region (RR = 0.84, 95% CI, 0.66 to 1.08, P = 0.179).
Probiotics could significantly decrease the risk of stage II-III NEC and death. Compared to using single probiotics species, the application of combining different probiotics has a better efficacy in the prevention of stage II-III NEC and death, especially in the Asian population.
坏死性小肠结肠炎（NEC）是早产儿发病和死亡的主要原因。为了评估益生菌在预防 II-III 期 NEC 中的疗效，我们对临床研究进行了荟萃分析。
我们检索了 1990 年 1 月 1 日至 2018 年 1 月 16 日期间的 PubMed、Medline 和 Embase 数据库。采用 Q 检验评估异质性。采用漏斗图和 Egger 回归检验评估发表偏倚。
符合纳入标准的 30 篇文章。数据显示，益生菌补充剂可显著降低 II-III 期 NEC 的发病风险（RR=0.51，95%CI，0.38 至 0.67，P<0.001）和死亡率（RR=0.69，95%CI，0.55 至 0.87，P=0.002）。混合益生菌和乳杆菌可降低 II-III 期 NEC 的发病风险（混合益生菌 RR=0.39，95%CI，0.26 至 0.57；乳杆菌 RR=0.53，95%CI，0.36 至 0.78），而双歧杆菌或酿酒酵母则没有这种效果。结果还表明，只有混合益生菌可降低死亡率（RR=0.52，95%CI，0.34 至 0.80）。亚组分析表明，益生菌在亚洲地区对死亡率有显著影响（RR=0.54，95%CI，0.37 至 0.80，P=0.002），而非亚洲地区则没有（RR=0.84，95%CI，0.66 至 1.08，P=0.179）。
益生菌可显著降低 II-III 期 NEC 和死亡的风险。与使用单一益生菌种类相比，联合使用不同的益生菌在预防 II-III 期 NEC 和死亡方面具有更好的疗效，特别是在亚洲人群中。
