Department of Paediatrics, Medical University of Warsaw, Poland.
Clin Nutr ESPEN. 2024 Oct;63:893-902. doi: 10.1016/j.clnesp.2024.08.010. Epub 2024 Aug 20.
BACKGROUND & AIMS: Studies have shown evidence of gut dysbiosis in individuals with autism spectrum disorder (ASD). Various microbiome-modifying treatments, including probiotics, have been proposed. This review systematically assessed the evidence on the effects of probiotics on core autism symptoms in children with ASD.
We performed a comprehensive literature search in Medline, Embase, CENTRAL, PsycInfo, and clinical trial registries, up to March 2023, and updated on January 10, 2024. Randomized controlled trials (RCTs) of parallel-group and cross-over designs were eligible. The population included individuals below 20 years of age diagnosed with ASD. Trials evaluating the effects of probiotics (any strain or dose) compared to placebo, no treatment, or another intervention were included. The outcomes of interest included the core autism symptoms: deficits in social skills, communication skills, and restricted, repetitive behaviors. No language restrictions were applied. Studies were excluded if an additional active compound was administered. The risk of bias was assessed using the Revised Cochrane Risk of Bias tool (RoB 2). This review was registered in PROSPERO (CRD42023393000).
In total, 12 RCTs assessing 630 participants were included. A borderline significant beneficial effect of probiotics on core ASD symptoms was found (8 RCTs, mean difference -0.21; 95% CI -0.39 to -0.03). Subgroup analysis according to study type showed a significant positive effect in parallel group trials (6 RCTs, mean difference -0.26; 95% CI -0.48 to -0.05). The pooled effect estimates for the other outcomes didn't reveal significant differences between the groups. Importantly, the risk of bias was high in nine studies.
Available data do not provide high-quality evidence supporting the use of probiotics for ASD symptoms in children.
研究表明，自闭症谱系障碍（ASD）患者存在肠道菌群失调。各种微生物组修饰治疗方法，包括益生菌，已被提出。本综述系统评估了益生菌对 ASD 儿童核心自闭症症状的影响。
我们在 Medline、Embase、CENTRAL、PsycInfo 和临床试验登记处进行了全面的文献检索，截至 2023 年 3 月，并于 2024 年 1 月 10 日更新。符合纳入标准的为平行组和交叉设计的随机对照试验（RCT）。纳入人群为年龄在 20 岁以下诊断为 ASD 的个体。纳入的试验评估了益生菌（任何菌株或剂量）与安慰剂、无治疗或其他干预措施的效果。主要结局包括核心自闭症症状：社交技能、沟通技能和受限、重复行为的缺陷。未应用语言限制。如果给予了额外的活性化合物，则排除研究。使用修订后的 Cochrane 偏倚风险工具（RoB 2）评估偏倚风险。本综述在 PROSPERO（CRD42023393000）中进行了注册。
共纳入了 12 项 RCT 研究，涉及 630 名参与者。益生菌对核心 ASD 症状有显著的有益作用（8 项 RCT，平均差异 -0.21；95%CI -0.39 至 -0.03）。根据研究类型进行的亚组分析显示，平行组试验中存在显著的积极效果（6 项 RCT，平均差异 -0.26；95%CI -0.48 至 -0.05）。其他结局的汇总效应估计值显示两组间无显著差异。重要的是，9 项研究的偏倚风险较高。
现有数据未提供高质量证据支持益生菌用于治疗儿童 ASD 症状。
