微生態制劑治療潰瘍性結腸炎的系統評價_《中國循證醫學雜志》

作者：

伍秋蓉 ¹ , 周雋 ¹ , 何繼東 ¹ ,  王一平 ² , 楊秀蓉 ¹ , 張蘭 ¹

1.雅安市第二人民醫院消化內科（雅安 625000）；2. 四川大學華西醫院消化科（成都 610041）;

關鍵詞：

微生態制劑潰瘍性結腸炎 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20080071

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目的　系統評價微生態制劑治療潰瘍性結腸炎的療效和安全性。
方法　計算機檢索Cochrane圖書館臨床對照試驗數據庫（2007年第1期）、MEDLINE/ PubMed（1978～2007）、EMbase（1978～2007）、Ovid（1978～2007）、中國生物醫學文獻數據庫（1978～2007）、中文科技期刊全文數據庫（1989～2007）、中國期刊全文數據庫（1979～2007）和萬方學位論文數據庫（1978～2007），手工檢索《中華消化雜志》等4種相關中文期刊、相關會議論文集及所有檢索到文獻的參考文獻，納入微生態制劑治療潰瘍性結腸炎的所有隨機對照試驗（RCT），并按Cochrane協作網推薦的方法進行系統評價。
結果　共納入13個RCT，包括1 146例患者。Meta分析結果顯示：① 臨床緩解率：微生態制劑不優于氨基類制劑［OR=0.93，95%CI（0.53，1.66），P=0.82］，但微生態制劑加氨基類制劑聯合治療優于氨基類制劑［OR=2.69，95%CI（1.57，4.61），P=0.000 3］。② 臨床復發率：微生態制劑治療優于安慰劑［OR=0.03，95%CI（0.00，0.15），P lt;0.000 1］；但不優于氨基類制劑［OR=0.95，95%CI（0.65，1.38），P=0.79］；微生態制劑加氨基類制劑聯合治療也不優于單純氨基類制劑治療［OR=0.57，95%CI（0.24，1.32），P=0.19］。③ 不良反應發生率：微生態制劑不優于氨基類制劑［OR=0.85，95%CI（0.43，1.70），P=0.65］；微生態制劑治療加氨基類制劑聯合治療也不優于氨基類制劑［OR=0.30，95%CI（0.06，1.54），P=0.15］。
結論　現有的證據顯示，在緩解潰瘍性結腸炎臨床癥狀方面，微生態制劑不優于氨基類制劑，但微生態制劑加氨基類制劑聯合治療優于單用氨基類制劑。在預防復發方面，微生態制劑優于安慰劑，但不優于氨基類制劑；微生態制劑加氨基類制劑聯合治療也不優于單用氨基類制劑治療。微生態制劑不良反應發生較少。鑒于本系統評價納入研究質量均不太高，因此對上述結果的應用應慎重，并期待進一步研究的證據。

引用本文： 伍秋蓉,周雋,何繼東,王一平,楊秀蓉,張蘭. 微生態制劑治療潰瘍性結腸炎的系統評價. 中國循證醫學雜志, 2008, 08(5): 315-321. doi: 10.7507/1672-2531.20080071 復制

1.	Fedorak RN, Madsen KL. Probiotics and the management of inflammatory bowel disease. Inflamm Bowel Dis, 2004, 10(3): 286-299.
2.	Shanahan F. Probiotics and inflammatory bowel disease: is there a scientific rationale? Inflamm Bowel Dis, 2000, 6(2): 107-115.
3.	Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hapatol, 2003, 15(6): 697-698.
4.	Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn’s disease in the Chinese population. Inflamm Bowel Dis, 2004, 10(5): 646-651.
5.	Heriasm V, Koninkx JF, Vos JG, et al. Probiotic effects of Lactobacillus caseion DSS - induced ulcerative colitis in mice. Int J Food Microbiol, 2005, 103(2): 143-155.
6.	Venturi A, Gionchetti P, Rizzello F, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther, 1999, 13(9): 1103-1108.
7.	Cui HH, Chen CL, Wang JD, et al. Effects of probiotic on intestinal mucosa of patients with ulcerative colitis. World J Gastroenterol, 2004, 10(10): 1521-1525.
8.	Kato K, Mizuno S, Umesaki Y, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther, 2004, 20(9): 1133-1141.
9.	Hideki I, Ikuko A, Yoshinori U, et al. Randomized Controlled Trial of the Effect of Bifidobacteria-Fermented Milk on Ulcerative Colitis. Journal of the American College of Nutrition, 2002, 22(1): 56-63.
10.	Antonio T, Giovanni B, Gian Marco G, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit, 2004, 10(11): 126-131.
11.	Kruis W, Fric P, Pokrotnieks J, et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut, 2004, 53(11): 1617-1623.
12.	Kruis W, Schutz E, Fric P, et al. double-blind comparison of an oral Escherichia coli preparation and mesalazine in Maintaining remission of ulcerative colitis. Aliment Pharmacol Ther, 1997, 23(11): 853-858.
13.	Furrie E, Macfarlane S, Kennedy A, et al. Synbiotic therapy (Bifidobacterium longum/Synergy 1)initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut, 2005, 54(9): 242-249.
14.	Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet, 1999, 35(4): 635-639.
15.	Zocco M A, ZileridavermeIL, Cremonini F, et al. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther, 2006, 23(11): 1567-1574.
16.	李國恩, 楊愛云, 謝明菊. 貝飛達治療潰瘍性結腸炎的療效觀察. 河南大學學報: 醫學科學版, 2003, 22(3): 40.
17.	向軍英, 馮迎春. 美常安聯合柳氮磺吡啶治療潰瘍性結腸炎22例. 世界華人消化雜志, 2006, 14(17): 1742-1744.
18.	李松財, 曹春宇, 湯武亨. 聯合應用美沙拉嗪和美常安膠囊治療潰瘍性結腸炎的臨床觀察. 現代中西醫結合雜志, 2006, 15(7): 900-901.
19.	姚玉川, 王磊輝, 趙江華, 等. 貝飛達灌腸治療潰瘍性直腸炎的療效. 中國微生態學志, 2005, 17(5): 378.
20.	Shanahan F. Probiotics and inflammatory bowel disease : from fads and fantasy to facts and future. Br J Nutr, 2002, 88(suppl 1): S5.
21.	McCarthy J, Mahony LO, Callaghan LO, et al. Double blind, placebo controlled trail of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut, 2003, 52(6): 975.
22.	Resta-Lenert S, Barrett KE. Live probiotics protect intestinal epithelial cell from the effects of Infection with enteroin-vasive Escherichia colis. Gut, 2003, 52(7): 988-997.
23.	Madsen K, Cornish A, Soper P, et al. Probiotic bacteria enhance murine and human intestinal epithelial barrier function. Gastroenterology, 2001, 112(3): 580-591.

1. Fedorak RN, Madsen KL. Probiotics and the management of inflammatory bowel disease. Inflamm Bowel Dis, 2004, 10(3): 286-299.
2. Shanahan F. Probiotics and inflammatory bowel disease: is there a scientific rationale? Inflamm Bowel Dis, 2000, 6(2): 107-115.
3. Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hapatol, 2003, 15(6): 697-698.
4. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn’s disease in the Chinese population. Inflamm Bowel Dis, 2004, 10(5): 646-651.
5. Heriasm V, Koninkx JF, Vos JG, et al. Probiotic effects of Lactobacillus caseion DSS - induced ulcerative colitis in mice. Int J Food Microbiol, 2005, 103(2): 143-155.
6. Venturi A, Gionchetti P, Rizzello F, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther, 1999, 13(9): 1103-1108.
7. Cui HH, Chen CL, Wang JD, et al. Effects of probiotic on intestinal mucosa of patients with ulcerative colitis. World J Gastroenterol, 2004, 10(10): 1521-1525.
8. Kato K, Mizuno S, Umesaki Y, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther, 2004, 20(9): 1133-1141.
9. Hideki I, Ikuko A, Yoshinori U, et al. Randomized Controlled Trial of the Effect of Bifidobacteria-Fermented Milk on Ulcerative Colitis. Journal of the American College of Nutrition, 2002, 22(1): 56-63.
10. Antonio T, Giovanni B, Gian Marco G, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit, 2004, 10(11): 126-131.
11. Kruis W, Fric P, Pokrotnieks J, et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut, 2004, 53(11): 1617-1623.
12. Kruis W, Schutz E, Fric P, et al. double-blind comparison of an oral Escherichia coli preparation and mesalazine in Maintaining remission of ulcerative colitis. Aliment Pharmacol Ther, 1997, 23(11): 853-858.
13. Furrie E, Macfarlane S, Kennedy A, et al. Synbiotic therapy (Bifidobacterium longum/Synergy 1)initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut, 2005, 54(9): 242-249.
14. Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet, 1999, 35(4): 635-639.
15. Zocco M A, ZileridavermeIL, Cremonini F, et al. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther, 2006, 23(11): 1567-1574.
16. 李國恩, 楊愛云, 謝明菊. 貝飛達治療潰瘍性結腸炎的療效觀察. 河南大學學報: 醫學科學版, 2003, 22(3): 40.
17. 向軍英, 馮迎春. 美常安聯合柳氮磺吡啶治療潰瘍性結腸炎22例. 世界華人消化雜志, 2006, 14(17): 1742-1744.
18. 李松財, 曹春宇, 湯武亨. 聯合應用美沙拉嗪和美常安膠囊治療潰瘍性結腸炎的臨床觀察. 現代中西醫結合雜志, 2006, 15(7): 900-901.
19. 姚玉川, 王磊輝, 趙江華, 等. 貝飛達灌腸治療潰瘍性直腸炎的療效. 中國微生態學志, 2005, 17(5): 378.
20. Shanahan F. Probiotics and inflammatory bowel disease : from fads and fantasy to facts and future. Br J Nutr, 2002, 88(suppl 1): S5.
21. McCarthy J, Mahony LO, Callaghan LO, et al. Double blind, placebo controlled trail of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut, 2003, 52(6): 975.
22. Resta-Lenert S, Barrett KE. Live probiotics protect intestinal epithelial cell from the effects of Infection with enteroin-vasive Escherichia colis. Gut, 2003, 52(7): 988-997.
23. Madsen K, Cornish A, Soper P, et al. Probiotic bacteria enhance murine and human intestinal epithelial barrier function. Gastroenterology, 2001, 112(3): 580-591.

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《中國循證醫學雜志》

微生態制劑治療潰瘍性結腸炎的系統評價

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