Habibi Arman, Letafatkar Negin, Sattari Nazila, Nobakht Sara, Rafat Zahra, Soltani Moghadam Saman, Mirdamadi Arian, Javid Mona, Jamilian Parsa, Hassanipour Soheil, Keivanlou Mohammad-Hossein, Amini-Salehi Ehsan
Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Clin Nutr ESPEN. 2025 Feb;65:93-104. doi: 10.1016/j.clnesp.2024.11.011. Epub 2024 Nov 16.
BACKGROUND & AIMS: Type 2 diabetes mellitus (T2DM) poses a significant global health challenge due to various lifestyle factors contributing to its prevalence and associated complications. Chronic low-grade inflammation, characterized by elevated levels of inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), plays a pivotal role in the pathogenesis of T2DM. Modulation of the gut microbiota through microbiome-targeted therapy (MTT), including probiotics, prebiotics, and synbiotics, has emerged as a potential strategy to mitigate inflammation and improve metabolic outcomes in T2DM.
A systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the impact of MTT on inflammatory markers in patients with T2DM. Searches were performed in PubMed, Scopus, and Web of Science databases up to June 2024, with inclusion criteria limited to English-language meta-analyses of randomized controlled trials (RCTs) assessing the effects of probiotics, prebiotics, or synbiotics on inflammatory markers in T2DM patients.
Ten meta-analyses met the inclusion criteria, comprising studies investigating the effects of various MTT interventions on CRP, IL-6, and TNF-α levels in T2DM patients. Meta-analysis results indicated significant reductions in CRP (SMD: -0.070; 95 % CI: -0.119 to -0.020) and TNF-α (SMD: -0.370; 95 % CI: -0.554 to -0.186) levels following MTT, while IL-6 reductions (SMD: -0.070; 95 % CI: -0.269 to 0.129) did not reach statistical significance. However, heterogeneity in study quality, intervention protocols, and participant demographics posed challenges in interpretation.
While improvements in inflammatory markers with MTT have been observed, significant limitations-such as heterogeneity in study quality and variation in intervention protocols-highlight the need for further research to confirm its efficacy and clarify underlying mechanisms. Future studies should aim to address these limitations by exploring variations in dosage, supplement formulations, and bacterial strains, which are crucial for improving the reliability and broader applicability of MTT in the management of T2DM.
由于多种生活方式因素导致2型糖尿病（T2DM）的患病率及其相关并发症，T2DM对全球健康构成了重大挑战。以C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）等炎症标志物水平升高为特征的慢性低度炎症在T2DM的发病机制中起关键作用。通过微生物群靶向治疗（MTT）调节肠道微生物群，包括益生菌、益生元及合生元，已成为减轻T2DM炎症并改善代谢结果的一种潜在策略。
按照PRISMA指南进行系统评价和荟萃分析，以评估MTT对T2DM患者炎症标志物的影响。截至2024年6月，在PubMed、Scopus和Web of Science数据库中进行检索，纳入标准仅限于评估益生菌、益生元或合生元对T2DM患者炎症标志物影响的随机对照试验（RCT）英文荟萃分析。
10项荟萃分析符合纳入标准，包括研究各种MTT干预对T2DM患者CRP、IL-6和TNF-α水平影响的研究。荟萃分析结果表明，MTT后CRP（标准化均值差：-0.070；95%置信区间：-0.119至-0.020）和TNF-α（标准化均值差：-0.370；95%置信区间：-0.554至-0.186）水平显著降低，而IL-6降低（标准化均值差：-0.070；95%置信区间：-0.269至0.129）未达到统计学显著性。然而，研究质量、干预方案和参与者人口统计学方面的异质性给解释带来了挑战。
虽然观察到MTT可改善炎症标志物，但研究质量的异质性和干预方案的差异等重大局限性凸显了进一步研究以确认其疗效并阐明潜在机制的必要性。未来的研究应旨在通过探索剂量、补充剂配方和菌株的差异来解决这些局限性，这对于提高MTT在T2DM管理中的可靠性和更广泛适用性至关重要。
