益生菌預防和治療支氣管哮喘的系統評價_《中國循證醫學雜志》

作者：

何敏 ¹ , 王婷 ¹ , 張紅萍 ² , 賈春娥 ² , 熊星宇 ¹ , 王剛 ² ,  姬郁林 ¹

1. 四川大學華西醫院呼吸內科（成都 610041）；2. 四川大學華西醫院中西醫結合科呼吸組（成都 610041）;

關鍵詞：

益生菌預防治療支氣管哮喘系統評價 Meta分析

DOI：

10.7507/1672-2531.20120072

視頻：

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目的　系統評價益生菌（合生元）對預防和治療支氣管哮喘（簡稱哮喘）的療效和安全性。
方法　計算機檢索PubMed、EMbase、Web of Science、OVID和Cochrane圖書館等電子數據庫，檢索時限從建庫至2011年8月，查找益生菌預防或治療哮喘患者的隨機對照試驗（RCT）。對符合條件的RCT，由兩位評價員獨立進行資料提取、質量評價并交叉核對后，采用RevMan 5.1軟件進行Meta分析。
結果　共納入益生菌預防哮喘的RCT 11個（n=3 656），益生菌治療哮喘的RCT 5個（n=430）。預防性研究Meta分析結果顯示，與安慰劑比較，益生菌在預防哮喘［RR=0.76，95%CI（0.47， 1.22），P=0.25］和喘息發生［RR=0.92，95%CI（0.62， 1.39），P=0.71］方面，差異無統計學意義。治療性研究Meta分析結果顯示，與安慰劑比較，益生菌能延長哮喘無癥狀持續時間［RR=1.48，95%CI（1.20， 1.76），P lt;0.000 1］。所有的RCT均無嚴重不良事件報道。
結論　現有證據尚不足以支持益生菌對哮喘的發生有預防作用，但益生菌治療可能延長兒童哮喘無癥狀持續時間，在一定程度可能具有改善肺功能的作用，但不能減少哮喘的急性發作，且亦未在改善免疫功能方面顯示優勢。

引用本文： 何敏,王婷,張紅萍,賈春娥,熊星宇,王剛,姬郁林. 益生菌預防和治療支氣管哮喘的系統評價. 中國循證醫學雜志, 2012, 12(4): 460-469. doi: 10.7507/1672-2531.20120072 復制

1.	Braman SS. The global burden of asthma. Chest, 2006, 130(suppl): 4S-12S.
2.	Rhodes L, Bailey CM, Moorman JE. Asthma prevalence and control characteristics by race/ethnicity—United States, 2002. MMWR Morb Mortal Wkly Rep, 2004, 53(4): 145-148.
3.	Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006475. DOI: 10.1002/14651858.CD006475.pub2.
4.	Strachan DP. Hay fever, hygiene, and household size. BMJ, 1989, 299(15): 1259-1260.
5.	Sudo N, Sawamura S, Tanaka K, et al. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol, 1997, 159(25): 1739-1745.
6.	BjÖrkstén B, Sepp E, Julge K, et al. Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol, 2001, 108(18): 516-520.
7.	Noverr MC, Huffnagle GB. The ‘‘microflora hypothesis’’ of allergic diseases. Clin Exp Allergy, 2005, 35(7): 1511-1520.
8.	Newburg DS. Oligosaccharides in human milk and bacterial colonization. J Pediatr Gastroenterol Nutr, 2000, 30(suppl 2): S8-17.
9.	Martinez FD, Holt PG. Role of microbial burden in aetiology of allergy and asthma. Lancet, 1999, 354(suppl 2): 12-15.
10.	Sanfilippo L, Li CK, Seth R, et al. Bacteroides fragilis enterotoxin induces the expression of IL-8 and transforming growth factor-beta (TGF-beta) by human colonic epithelial cells. Clin Exp Immunol, 2000, 119(6): 456-463.
11.	Gaskins HR. Immunological aspects of host/microbiota interactions at the intestinal epithelium. In: Mackie RI, White BA, Isaacson RE, eds.Gastrointestinal microbiology. New York: International Thomson Publishing, 1997: 537–587.
12.	Salminen S, Bouley C, Boutron-Ruault MC, et al. Functional food science and gastrointestinal physiology and function. Br J Nutr, 1998, 80 (suppl 1): 147-171.
13.	Guarner F, Schaafsma GJ. Probiotics. International Journal of Food Microbiology, 1998, 39(16): 237-238.
14.	Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol, 1997, 99(4): 179-185.
15.	Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy, 2005, 60(5): 494-500.
16.	Rosenfeldt V, Benfeldt E, Nielsen SD, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol, 2003, 111(2): 389-395.
17.	Weston S, HalbertA, Richmond P, et al. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child, 2005, 90(7): 892-897.
18.	Forsythe P, Inman MD, Bienenstock J. Oral treatment with live Lactobacillus reuteri inhibits the allergic airway response in mice. Am J Respir Crit Care Med, 2007, 175(16): 561-569.
19.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochranehandbook.org.
20.	van der Aa LB, van Aalderen WMC, Heymans HSA, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy, 2011, 66(10): 170-177.
21.	Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: A randomized, double-blind, placebo-controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(8): 192-198.
22.	Kuitunen M, Kukkonen K, Juntunen-Backman K, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. Journal of Allergy and Clinical Immunology, 2009, 123(3): 335-341.
23.	Kalliomäki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial. Lancet, 2001, 357(6): 1076-1079.
24.	Kukkonen AK, Kuitunen M, Savilahti E, et al. Airway inflammation in probiotic-treated children at 5 years. Pediatr Allergy and Immunol, 2011, 22(4): 249-251.
25.	Dotterud CK, Storrø O, Johnsen R, et al. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. British Journal of Dermatology, 2010, 163(15): 616-623.
26.	Taylor A, Hale J, Wiltschut J, et al. Evaluation of the effects of probiotic supplementation from the neonatal period on innate immune development in infancy. Clinical and Experimental Allergy, 2006, 36(12): 1218-1226.
27.	Abrahamsson TR, Jakobsson T, Bottcher MF, et al. Probiotics in prevention of IgE-associated eczema: A double-blind, randomized,placebo-controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(15): 1174-1180.
28.	Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: A randomized controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(15): 184-191.
29.	Kopp MV, Hennemuth I, Heinzmann A, et al. Randomized, Double-Blind, Placebo-Controlled Trial of Probiotics for Primary Prevention: No Clinical Effects of Lactobacillus GG Supplementation. Pediatrics, 2008, 121(4): 850-856.
30.	Arslanoglu S, Moro GE, Schmitt J, et al. Early Dietary Intervention with a Mixture of Prebiotic Oligosaccharides Reduces the Incidence of Allergic Manifestations and Infections during the First Two Years of Life. The Journal of Nutrition, 2008, 138(6): 1091-1095.
31.	van de Pol MA, Lutter R, Smids BS, et al. Synbiotics reduce allergen-induced T-helper 2 response and improve peak expiratory flow in allergic asthmatics. Allergy, 2011, 66(31): 39-47.
32.	Rose MA, Stieglitz F, K?ksal A, et al. Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk. Clinical & Experimental Allergy, 2010, 67(40): 1398-1405.
33.	Chen YS, Jan RL, Lin LY, et al. Randomized Placebo-Controlled Trial of Lactobacillus on Asthmatic Children With Allergic Rhinitis. Pediatric Pulmonology, 2010, 54(45): 1111-1120.
34.	Giovannini M, Agostoni C, Riva E, et al. A Randomized Prospective Double Blind Controlled Trial on Effects of Long-Term Consumption of Fermented Milk Containing Lactobacillus casei in Pre-School Children With Allergic Asthma and/or Rhinitis. Pediatric Research, 2007, 51(62): 215-220.
35.	Gutkowski P, Madalinski K, Grek M, et al. Effect of orally administered probiotic strains Lactobacillus and Bifidobacterium in children with atopic asthma. Centr Eur J Immunol, 2010, 35(4): 233-238.
36.	Noverr MC, Huffnagle GB. Does the microbiota regulate immune responses outside the gut? Trends Microbiol, 2004, 12(6): 562-568.
37.	Penders J, Stobberingh EE, van den Brandt PA, et al. The role of the intestinal microbiota in the development of atopic disorders. Allergy, 2007, 62(7): 1223-1236.
38.	Feleszko W, Jaworska J, Hamelmann E. Toll-like receptors: novel targets in allergic airway disease (probiotics, friends and relatives). Eur J Pharmacol, 2006, 533(12): 308-318.

1. Braman SS. The global burden of asthma. Chest, 2006, 130(suppl): 4S-12S.
2. Rhodes L, Bailey CM, Moorman JE. Asthma prevalence and control characteristics by race/ethnicity—United States, 2002. MMWR Morb Mortal Wkly Rep, 2004, 53(4): 145-148.
3. Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006475. DOI: 10.1002/14651858.CD006475.pub2.
4. Strachan DP. Hay fever, hygiene, and household size. BMJ, 1989, 299(15): 1259-1260.
5. Sudo N, Sawamura S, Tanaka K, et al. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol, 1997, 159(25): 1739-1745.
6. BjÖrkstén B, Sepp E, Julge K, et al. Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol, 2001, 108(18): 516-520.
7. Noverr MC, Huffnagle GB. The ‘‘microflora hypothesis’’ of allergic diseases. Clin Exp Allergy, 2005, 35(7): 1511-1520.
8. Newburg DS. Oligosaccharides in human milk and bacterial colonization. J Pediatr Gastroenterol Nutr, 2000, 30(suppl 2): S8-17.
9. Martinez FD, Holt PG. Role of microbial burden in aetiology of allergy and asthma. Lancet, 1999, 354(suppl 2): 12-15.
10. Sanfilippo L, Li CK, Seth R, et al. Bacteroides fragilis enterotoxin induces the expression of IL-8 and transforming growth factor-beta (TGF-beta) by human colonic epithelial cells. Clin Exp Immunol, 2000, 119(6): 456-463.
11. Gaskins HR. Immunological aspects of host/microbiota interactions at the intestinal epithelium. In: Mackie RI, White BA, Isaacson RE, eds.Gastrointestinal microbiology. New York: International Thomson Publishing, 1997: 537–587.
12. Salminen S, Bouley C, Boutron-Ruault MC, et al. Functional food science and gastrointestinal physiology and function. Br J Nutr, 1998, 80 (suppl 1): 147-171.
13. Guarner F, Schaafsma GJ. Probiotics. International Journal of Food Microbiology, 1998, 39(16): 237-238.
14. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol, 1997, 99(4): 179-185.
15. Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy, 2005, 60(5): 494-500.
16. Rosenfeldt V, Benfeldt E, Nielsen SD, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol, 2003, 111(2): 389-395.
17. Weston S, HalbertA, Richmond P, et al. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child, 2005, 90(7): 892-897.
18. Forsythe P, Inman MD, Bienenstock J. Oral treatment with live Lactobacillus reuteri inhibits the allergic airway response in mice. Am J Respir Crit Care Med, 2007, 175(16): 561-569.
19. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochranehandbook.org.
20. van der Aa LB, van Aalderen WMC, Heymans HSA, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy, 2011, 66(10): 170-177.
21. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: A randomized, double-blind, placebo-controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(8): 192-198.
22. Kuitunen M, Kukkonen K, Juntunen-Backman K, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. Journal of Allergy and Clinical Immunology, 2009, 123(3): 335-341.
23. Kalliomäki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial. Lancet, 2001, 357(6): 1076-1079.
24. Kukkonen AK, Kuitunen M, Savilahti E, et al. Airway inflammation in probiotic-treated children at 5 years. Pediatr Allergy and Immunol, 2011, 22(4): 249-251.
25. Dotterud CK, Storrø O, Johnsen R, et al. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. British Journal of Dermatology, 2010, 163(15): 616-623.
26. Taylor A, Hale J, Wiltschut J, et al. Evaluation of the effects of probiotic supplementation from the neonatal period on innate immune development in infancy. Clinical and Experimental Allergy, 2006, 36(12): 1218-1226.
27. Abrahamsson TR, Jakobsson T, Bottcher MF, et al. Probiotics in prevention of IgE-associated eczema: A double-blind, randomized,placebo-controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(15): 1174-1180.
28. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: A randomized controlled trial. Journal of Allergy and Clinical Immunology, 2007, 119(15): 184-191.
29. Kopp MV, Hennemuth I, Heinzmann A, et al. Randomized, Double-Blind, Placebo-Controlled Trial of Probiotics for Primary Prevention: No Clinical Effects of Lactobacillus GG Supplementation. Pediatrics, 2008, 121(4): 850-856.
30. Arslanoglu S, Moro GE, Schmitt J, et al. Early Dietary Intervention with a Mixture of Prebiotic Oligosaccharides Reduces the Incidence of Allergic Manifestations and Infections during the First Two Years of Life. The Journal of Nutrition, 2008, 138(6): 1091-1095.
31. van de Pol MA, Lutter R, Smids BS, et al. Synbiotics reduce allergen-induced T-helper 2 response and improve peak expiratory flow in allergic asthmatics. Allergy, 2011, 66(31): 39-47.
32. Rose MA, Stieglitz F, K?ksal A, et al. Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk. Clinical & Experimental Allergy, 2010, 67(40): 1398-1405.
33. Chen YS, Jan RL, Lin LY, et al. Randomized Placebo-Controlled Trial of Lactobacillus on Asthmatic Children With Allergic Rhinitis. Pediatric Pulmonology, 2010, 54(45): 1111-1120.
34. Giovannini M, Agostoni C, Riva E, et al. A Randomized Prospective Double Blind Controlled Trial on Effects of Long-Term Consumption of Fermented Milk Containing Lactobacillus casei in Pre-School Children With Allergic Asthma and/or Rhinitis. Pediatric Research, 2007, 51(62): 215-220.
35. Gutkowski P, Madalinski K, Grek M, et al. Effect of orally administered probiotic strains Lactobacillus and Bifidobacterium in children with atopic asthma. Centr Eur J Immunol, 2010, 35(4): 233-238.
36. Noverr MC, Huffnagle GB. Does the microbiota regulate immune responses outside the gut? Trends Microbiol, 2004, 12(6): 562-568.
37. Penders J, Stobberingh EE, van den Brandt PA, et al. The role of the intestinal microbiota in the development of atopic disorders. Allergy, 2007, 62(7): 1223-1236.
38. Feleszko W, Jaworska J, Hamelmann E. Toll-like receptors: novel targets in allergic airway disease (probiotics, friends and relatives). Eur J Pharmacol, 2006, 533(12): 308-318.

《中國循證醫學雜志》

益生菌預防和治療支氣管哮喘的系統評價

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《中國循證醫學雜志》

益生菌預防和治療支氣管哮喘的系統評價

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