补充益生菌/合生元对慢性肾病患者的疗效：一项随机对照试验的系统评价和荟萃分析
Efficacy of probiotics/synbiotics supplementation in patients with chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Liu Chang, Yang Letian, Wei Wei, Fu Ping
机构信息
Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu, China.
出版信息
Front Nutr. 2024 Aug 6;11:1434613. doi: 10.3389/fnut.2024.1434613. eCollection 2024.
BACKGROUND
Chronic kidney disease (CKD) is a serious and steadily growing health problem worldwide. Probiotic and synbiotic supplementation are expected to improve kidney function in CKD patients by altering imbalanced intestinal flora, regulating microbiota metabolites, modulating the brain-gut axis, and reducing inflammation.
OBJECTIVES
Our aim is to report the latest and largest pooled analyses and evidence updates to explore whether probiotic and synbiotic have beneficial effects on renal function and general conditions in patients with CKD.
METHODS
We conducted a systematic literature search using PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until 1 December 2023. Eligible literatures were screened according to inclusion and exclusion criteria, data were extracted, and a systematic review and meta-analysis was performed. Measurements included renal function-related markers, inflammatory markers, uremic toxins, lipid metabolism-related markers and electrolytes levels.
RESULTS
Twenty-one studies were included. The results showed that probiotic/synbiotic significantly reduced blood urea nitrogen (BUN) (standardized mean difference (SMD), -0.23, 95% confidence interval (CI) -0.41, -0.04; = 0.02, I = 10%) and lowered c-reactive protein level (CRP) (SMD: -0.34; 95% CI: -0.62, -0.07; = 0.01, I = 37%) in CKD patients, compared with the control group.
CONCLUSION
In summary, probiotic/synbiotic supplementation seems to be effective in improving renal function indices and inflammation indices in CKD patients. Subgroup analyses suggested that longer-term supplementation is more favorable for CKD patients, but there is a high degree of heterogeneity in the results of partial subgroup analyses. The efficacy of probiotic/synbiotic in treating CKD needs to be supported by more evidence from large-scale clinical studies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024526836, Unique identifier: CRD42024526836.
背景
慢性肾脏病（CKD）是全球范围内一个严重且不断发展的健康问题。补充益生菌和合生元有望通过改变失衡的肠道菌群、调节微生物群代谢产物、调节脑-肠轴以及减轻炎症来改善CKD患者的肾功能。
目的
我们的目的是报告最新且规模最大的汇总分析和证据更新情况，以探讨益生菌和合生元对CKD患者的肾功能和一般状况是否具有有益作用。
方法
我们使用PubMed、Embase、Web of Science和Cochrane对照试验中心注册库进行了一项系统的文献检索，检索时间从数据库创建至2023年12月1日。根据纳入和排除标准筛选符合条件的文献，提取数据，并进行系统评价和荟萃分析。测量指标包括肾功能相关标志物、炎症标志物、尿毒症毒素、脂质代谢相关标志物和电解质水平。
结果
纳入了21项研究。结果显示，与对照组相比，益生菌/合生元显著降低了CKD患者的血尿素氮（BUN）（标准化均值差（SMD），-0.23，95%置信区间（CI）-0.41，-0.04；P = 0.02，I² = 10%）并降低了C反应蛋白水平（CRP）（SMD：-0.34；95%CI：-0.62，-0.07；P = 0.01，I² = 37%）。
结论
总之，补充益生菌/合生元似乎对改善CKD患者的肾功能指标和炎症指标有效。亚组分析表明，长期补充对CKD患者更有利，但部分亚组分析结果存在高度异质性。益生菌/合生元治疗CKD的疗效需要更多大规模临床研究的证据支持。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024526836，唯一标识符：CRD42024526836。
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