Lu Dongxue, Yan Jing, Liu Feng, Ding Pinpin, Chen Bingyu, Lu Yin, Sun Zhiguang
First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Gastroenterology department, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Asia Pac J Clin Nutr. 2019;28(4):701-710. doi: 10.6133/apjcn.201912_28(4).0005.
To systematically assess the safety and effectiveness of probiotics in preventing and treating chemotherapy-induced diarrhea (CID), so as to provide the evidence-based evidence for clinical practice.
Electronic databases, including EMbase, Cochrane Library, pubMed, CNKI, VIP, CBM, and Wanfang databases, were retrieved to search for the randomized controlled trials (RCTs) of CIDs among patients with malignant tumors treated with probiotics as of March 2019. Later, the Rev Man 5.3 statistical software was employed to extract data and assess the quality of the identified literature for metaanalysis.
Finally, 13 RCTs involving a total of 1024 patients were included into the current metaanalysis. Results of this meta-analysis showed that the addition of probiotics to conventional symptomatic treatment could evidently reduce the total diarrhea rate in patients with cancer [RR=0.47, 95% CI (0.35, 0.63), p<0.00001] and grade III-IV diarrhea [RR=0.16, 95% CI (0.05, 0.42), p=0.0008], increase the total effective rate [OR=4.26, 95% CI (2.55, 7.12), p<0.00001], and shorten the duration of diarrhea [MD=-1.92, 95% CI (-1.96, - 1.88), p<0.00001]; meanwhile, the difference was statistically significant. But in patients with grade I-II diarrhea [RR=0.81, 95% CI (0.53, 1.24), p=0.34], the difference was not statistically significant. Besides, none of the enrolled study had reported adverse reactions.
The application of probiotics before or during chemotherapy can effectively prevent the occurrence of CID among cancer patients. Moreover, the combination of probiotics in treating CID can also improve the therapeutic effect on CID, with less adverse events.
系统评价益生菌预防和治疗化疗所致腹泻（CID）的安全性和有效性，为临床实践提供循证依据。
检索电子数据库，包括EMbase、Cochrane图书馆、PubMed、中国知网（CNKI）、维普资讯（VIP）、中国生物医学文献数据库（CBM）和万方数据库，以查找截至2019年3月使用益生菌治疗的恶性肿瘤患者中CID的随机对照试验（RCT）。随后，采用Rev Man 5.3统计软件提取数据并评估纳入文献的质量以进行荟萃分析。
最终，13项RCT共纳入1024例患者进行当前的荟萃分析。该荟萃分析结果显示，在常规对症治疗基础上加用益生菌可明显降低癌症患者的总腹泻率[相对危险度（RR）=0.47，95%可信区间（CI）（0.35，0.63），P<0.00001]和Ⅲ-Ⅳ级腹泻率[RR=0.16，95%CI（0.05，0.42），P=0.0008]，提高总有效率[比值比（OR）=4.26，95%CI（2.55，7.12），P<0.00001]，缩短腹泻持续时间[平均差（MD）=-1.92，95%CI（-1.96，-1.88），P<0.00001]；同时，差异具有统计学意义。但在Ⅰ-Ⅱ级腹泻患者中[RR=0.81，95%CI（0.53，1.24），P=0.34]，差异无统计学意义。此外，纳入的研究均未报告不良反应。
化疗前或化疗期间应用益生菌可有效预防癌症患者发生CID。此外，益生菌联合治疗CID还可提高对CID的治疗效果，且不良事件较少。
