不同益生菌产品联合泻药治疗小儿功能性便秘的疗效和可接受性:随机对照试验的网络荟萃分析。
Efficacy and acceptability of different probiotic products plus laxatives for pediatric functional constipation: a network meta-analysis of randomized controlled trials.
机构信息
Department of Pediatrics, Ping An Medical Clinic, Tainan, Taiwan.
Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
出版信息
Eur J Pediatr. 2024 Aug;183(8):3531-3541. doi: 10.1007/s00431-024-05568-6. Epub 2024 May 29.
The prevalence of pediatric constipation ranges from 0.7 to 29.6% across different countries. Functional constipation accounts for 95% of pediatric constipation, and the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. We aimed to compare the efficacy and acceptability of different probiotic supplements for pediatric functional constipation. The current frequentist model-based network meta-analysis (NMA) included RCTs of probiotic supplements for functional constipation in children. The primary outcome was changes in bowel movement or stool frequency; acceptability outcome was all-cause discontinuation. Nine RCTs were included (N = 710; mean age = 5.5 years; 49.4% girls). Most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives (standardized mean difference (SMD) = 1.87, 95% confidence interval (95% CI) = 0.85 to 2.90) were associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments (SMD = 1.37, 95% CI: 0.32 to 2.43). All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments. Conclusion: The results of our NMA support the application of an advanced combination of probiotics and laxatives for pediatric functional constipation if there is no concurrent contraindication. Registration: PROSPERO (CRD42022298724). What is Known: • Despite of the high prevalence of pediatric constipation, which ranges from 0.7% to 29.6%, the efficacy of pharmacotherapy is limited, with a success rate of 60%. Several randomized controlled trials (RCTs) have shown the benefits of probiotic supplements in treating this condition. However, the reported strains of probiotics varied among the RCTs. The widely heterogeneous strains of probiotics let the traditional meta-analysis, which pooled all different strains into one group, be nonsense and insignificant. What is New: • By conducting a comprehensive network meta-analysis, we aimed to compare the efficacy and acceptability of different strains of probiotic supplements for pediatric functional constipation. Network meta-analysis of nine randomized controlled trials revealed that the most probiotic products, used either alone or combined with laxatives, were associated with significantly better improvement in bowel movement or stool frequency than placebo/control. Protexin plus laxatives was associated with the greatest improvement in bowel movement or stool frequency among all the investigated probiotic products. For the single probiotic interventions, only Lactobacillus casei rhamnosus Lcr35 was associated with significant efficacy compared to placebo/control treatments. All the investigated probiotic products had fecal incontinence and patient drop-out rates similar to those of placebo/control treatments.
儿科便秘的患病率在不同国家为 0.7%至 29.6%不等。功能性便秘占儿科便秘的 95%,药物治疗的疗效有限,成功率为 60%。几项随机对照试验(RCT)表明益生菌补充剂在治疗这种疾病方面的益处。然而,RCT 中报告的益生菌菌株各不相同。我们旨在比较不同益生菌补充剂治疗小儿功能性便秘的疗效和可接受性。目前的频率论基于模型的网络荟萃分析(NMA)纳入了儿童功能性便秘的益生菌补充剂 RCT。主要结局是粪便运动或粪便频率的变化;可接受性结局是所有原因的停药。纳入了 9 项 RCT(N=710;平均年龄=5.5 岁;49.4%为女孩)。与安慰剂/对照相比,大多数益生菌产品(单独使用或与泻药联合使用)在改善粪便运动或粪便频率方面有显著改善。与所有研究的益生菌产品相比,Protexin 加泻药(标准化均数差(SMD)=1.87,95%置信区间(95%CI)=0.85 至 2.90)与粪便运动或粪便频率的最大改善相关。对于单一益生菌干预,只有鼠李糖乳杆菌 Lcr35 与安慰剂/对照治疗相比具有显著疗效(SMD=1.37,95%CI:0.32 至 2.43)。所有研究的益生菌产品在粪便失禁和患者脱落率方面与安慰剂/对照治疗相似。结论:我们的 NMA 结果支持在没有合并禁忌症的情况下应用益生菌和泻药的先进组合治疗小儿功能性便秘。注册:PROSPERO(CRD42022298724)。已知的:•尽管儿科便秘的患病率很高,范围为 0.7%至 29.6%,但药物治疗的疗效有限,成功率为 60%。几项随机对照试验(RCT)表明益生菌补充剂在治疗这种疾病方面的益处。然而,RCT 中报告的益生菌菌株各不相同。益生菌的广泛异质菌株使得传统的荟萃分析(将所有不同的菌株合并为一组)毫无意义和不重要。新的:•通过进行全面的网络荟萃分析,我们旨在比较不同菌株的益生菌补充剂治疗小儿功能性便秘的疗效和可接受性。对 9 项随机对照试验的网络荟萃分析表明,与安慰剂/对照相比,大多数益生菌产品(单独使用或与泻药联合使用)在改善粪便运动或粪便频率方面有显著改善。在所有研究的益生菌产品中,Protexin 加泻药与粪便运动或粪便频率的最大改善相关。对于单一益生菌干预,只有鼠李糖乳杆菌 Lcr35 与安慰剂/对照治疗相比具有显著疗效。所有研究的益生菌产品在粪便失禁和患者脱落率方面与安慰剂/对照治疗相似。