China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi'an 710061, China.
Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi'an 710061, China.
Nutrients. 2021 Nov 29;13(12):4319. doi: 10.3390/nu13124319.
Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, [mean difference (MD) = -0.84 day; 95% confidence interval (CI), -1.39, -0.29], (MD = -0.98 day; 95%CI, -1.82, -0.14), (MD = -1.25 day; 95%CI, -1.59, -0.91), (spp.) plus spp. plus spp. (MD = -1.19 day; 95%CI, -1.81, -0.58), and spp. plus spp. plus spp. (MD = -1.1 day; 95%CI, -1.84, -0.35) significantly reduced the duration of diarrhea when compared with placebo. [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.
急性腹泻是导致 5 岁以下儿童发病和死亡的主要原因。益生菌对儿童急性腹泻的治疗有益，但哪种特定益生菌最有效尚不清楚。我们进行了贝叶斯网状meta 分析，以研究益生菌的比较疗效。通过检索 EMBASE、PubMed 和 Cochrane Library，我们纳入了截至 2021 年 3 月 31 日关于益生菌治疗儿童急性腹泻的随机临床试验（RCT）。主要结局包括腹泻持续时间和腹泻持续时间≥2 天，次要结局包括第 2 天平均粪便频率和住院时间、发热和呕吐。我们根据推荐评估、制定与评估（GRADE）指南评估结局证据的确定性。纳入了 84 项研究，涉及 13443 名儿童的 21 种不同干预措施。对于主要结局，中等质量证据表明，[均数差（MD）=-0.84 天；95%置信区间（CI）：-1.39，-0.29]，[MD=-0.98 天；95%CI：-1.82，-0.14]，[MD=-1.25 天；95%CI：-1.59，-0.91]，[混合 spp.+ spp.+ spp.（MD=-1.19 天；95%CI：-1.81，-0.58）]和[spp.+ spp.+ spp.（MD=-1.1 天；95%CI：-1.84，-0.35）]与安慰剂相比显著降低腹泻持续时间。[比值比（OR）=0.22；95%CI：0.11，0.41]和[OR=0.23；95%CI：0.090，0.60]与安慰剂或无治疗相比显著降低腹泻持续时间≥2 天的风险，具有中等质量证据。在所有益生菌中，[MD=-0.16 天；95%CI：-0.29，-0.03]可能是最有效的，与安慰剂相比，不仅能显著降低腹泻持续时间，而且降低腹泻持续时间≥2 天的风险（与安慰剂或无治疗相比），具有中等质量证据。为了得出结论，[MD=-0.41 天；95%CI：-0.67，-0.15]可能是治疗儿童急性腹泻最有效的益生菌，其次是其他几种单菌株和多菌株益生菌。
