肠道微生物组操纵对非酒精性脂肪性肝病患者血糖指数的影响：综合伞状评价。

The effects of gut microbiome manipulation on glycemic indices in patients with non-alcoholic fatty liver disease: a comprehensive umbrella review.

机构信息

Guilan University of Medical Sciences, Rasht, Iran.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.

出版信息

Nutr Diabetes. 2024 May 10;14(1):25. doi: 10.1038/s41387-024-00281-7.

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a significant risk factor for non-alcoholic fatty liver disease (NAFLD). Increased fasting blood sugar (FBS), fasting insulin (FI), and insulin resistance (HOMA-IR) are observed in patients with NAFLD. Gut microbial modulation using prebiotics, probiotics, and synbiotics has shown promise in NAFLD treatment. This meta-umbrella study aimed to investigate the effects of gut microbial modulation on glycemic indices in patients with NAFLD and discuss potential mechanisms of action.

METHODS

A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library until March 2023 for meta-analyses evaluating the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD. Random-effect models, sensitivity analysis, and subgroup analysis were employed.

RESULTS

Gut microbial therapy significantly decreased HOMA-IR (ES: -0.41; 95%CI: -0.52, -0.31; P < 0.001) and FI (ES: -0.59; 95%CI: -0.77, -0.41; P < 0.001). However, no significant effect was observed on FBS (ES: -0.17; 95%CI: -0.36, 0.02; P = 0.082). Subgroup analysis revealed prebiotics had the most potent effect on HOMA-IR, followed by probiotics and synbiotics. For FI, synbiotics had the most substantial effect, followed by prebiotics and probiotics.

CONCLUSION

Probiotics, prebiotics, and synbiotics administration significantly reduced FI and HOMA-IR, but no significant effect was observed on FBS.

背景

2 型糖尿病（T2DM）是非酒精性脂肪性肝病（NAFLD）的重要危险因素。NAFLD 患者存在空腹血糖（FBS）、空腹胰岛素（FI）和胰岛素抵抗（HOMA-IR）升高的情况。使用益生元、益生菌和合生元调节肠道微生物已显示出在 NAFLD 治疗中的潜力。本元分析旨在研究肠道微生物调节对 NAFLD 患者血糖指标的影响，并探讨其潜在的作用机制。

方法

对 PubMed、Web of Science、Scopus 和 Cochrane Library 进行系统检索，以评估益生菌、益生元和合生元对 NAFLD 患者影响的元分析，检索时间截至 2023 年 3 月。采用随机效应模型、敏感性分析和亚组分析。

结果

肠道微生物治疗显著降低了 HOMA-IR（ES：-0.41；95%CI：-0.52，-0.31；P<0.001）和 FI（ES：-0.59；95%CI：-0.77，-0.41；P<0.001）。然而，FBS 没有观察到显著的影响（ES：-0.17；95%CI：-0.36，0.02；P=0.082）。亚组分析表明，在 HOMA-IR 方面，益生元的作用最强，其次是益生菌和合生元；在 FI 方面，合生元的作用最显著，其次是益生元和益生菌。