益生菌治療腸易激綜合征隨機對照試驗的系統評價_《中國循證醫學雜志》

作者：

舒小闖 , 周淑萍 , 陳春燕 , 王少東 ,  汪芳裕

南京大學醫學院臨床學院（南京軍區南京總醫院）消化內科（南京 210002）;

關鍵詞：

益生菌腸易激綜合征 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120128

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價益生菌治療腸易激綜合征（IBS）的療效。
方法　計算機檢索PubMed、Cochrane Library、Web of Sicence、EMbase、MD Consult、CNKI、CBM、WanFang Data中關于益生菌與安慰劑對照治療IBS的隨機對照試驗。文獻檢索時限均從建庫至2011年6月。由兩名研究者按照Cochrane 系統評價員手冊5.0.1標準獨立評價文獻質量、提取資料并交叉核對后，使用RevMan 5.1軟件進行Meta分析。
結果　共納入20個隨機對照試驗，1 713例患者。Meta分析結果顯示：益生菌與安慰劑相比，在改善IBS總體癥狀、腹痛/腹部不適、腹脹方面，兩組差異均有統計學意義。
結論　現有證據表明，益生菌對改善IBS癥狀有一定療效。但由于納入研究的方法學質量及各研究間診斷標準、評價方法、劑量、療程等諸多方面存在差異，上述結論還需更多設計嚴格的高質量RCT進一步證實。

引用本文： 舒小闖,周淑萍,陳春燕,王少東,汪芳裕. 益生菌治療腸易激綜合征隨機對照試驗的系統評價. 中國循證醫學雜志, 2012, 12(7): 840-847. doi: 10.7507/1672-2531.20120128 復制

1.	熊理守, 陳旻湖, 陳惠新, 等. 廣東省社區人群腸易激綜合征的流行病學研究. 中華醫學雜志, 2004, (4): 18-21.
2.	中華醫學會消化病學分會胃腸動力學組. 腸易激綜合征診斷和治療的共識意見 (2007, 長沙). 中華消化雜志, 2008, 28(1): 3.
3.	Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95(5): 1231-1238.
4.	O’Sullivan MA, O’Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis, 2000, 32(4): 294-301.
5.	Kim HJ, Camilleri M, Mckinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17(7): 895-904.
6.	Kajander K, Hatakka K, Poussa T, et al. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22(5): 387-394.
7.	Kim HJ, Vazquez RM, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil, 2005, 17(5): 687-696.
8.	Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome--a double blind, placebo-controlled, randomized study. Clin Nutr, 2005, 24(6): 925-931.
9.	O’Mahony L, Mccarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology, 2005, 128(3): 541-551.
10.	Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101(7): 1581-1590.
11.	Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther, 2007, 26(3): 475-486.
12.	Andriulli A, Neri M, Loguercio C, et al. Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study. J Clin Gastroenterol, 2008, 42 Suppl 3 Pt 2(8): S218-S223.
13.	Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
14.	Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
15.	Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53(10): 2714-2718.
16.	Williams EA, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther, 2008, 29(1): 97-103.
17.	Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2009, 29(1): 104-114.
18.	Hong KS, Kang HW, Im JP, et al. Effect of probiotics on symptoms in korean adults with irritable bowel syndrome. Gut Liver, 2009, 3(2): 101-107.
19.	Simren M, Ohman L, Olsson J, et al. Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - a randomized, double-blind, controlled study. Aliment Pharmacol Ther, 2010, 31(2): 218-227.
20.	Guglielmetti S, Mora D, Gschwender M, et al. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life - a double-blind, placebo-controlled study. Aliment Pharmacol Ther, 2011, 33(10): 1123-1132.
21.	Hong YS, Hong KS, Park MH, et al. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45(5): 415-425.
22.	Sondergaard B, Olsson J, Ohlson K, et al. Effects of probiotic fermented milk on symptoms and intestinal flora in patients with irritable bowel syndrome: a randomized, placebo-controlled trial. Scand J Gastroenterol, 2011, 46(6): 663-672.
23.	Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther, 2011, 33(12): 1302-1310.
24.	Aragon G, Graham DB, Borum M, et al. Probiotic therapy for irritable bowel syndrome. Gastroenterol Hepatol (NY), 2010, 6(1): 39-44.

1. 熊理守, 陳旻湖, 陳惠新, 等. 廣東省社區人群腸易激綜合征的流行病學研究. 中華醫學雜志, 2004, (4): 18-21.
2. 中華醫學會消化病學分會胃腸動力學組. 腸易激綜合征診斷和治療的共識意見 (2007, 長沙). 中華消化雜志, 2008, 28(1): 3.
3. Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95(5): 1231-1238.
4. O’Sullivan MA, O’Morain CA. Bacterial supplementation in the irritable bowel syndrome. A randomised double-blind placebo-controlled crossover study. Dig Liver Dis, 2000, 32(4): 294-301.
5. Kim HJ, Camilleri M, Mckinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17(7): 895-904.
6. Kajander K, Hatakka K, Poussa T, et al. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22(5): 387-394.
7. Kim HJ, Vazquez RM, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil, 2005, 17(5): 687-696.
8. Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome--a double blind, placebo-controlled, randomized study. Clin Nutr, 2005, 24(6): 925-931.
9. O’Mahony L, Mccarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology, 2005, 128(3): 541-551.
10. Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101(7): 1581-1590.
11. Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther, 2007, 26(3): 475-486.
12. Andriulli A, Neri M, Loguercio C, et al. Clinical trial on the efficacy of a new symbiotic formulation, Flortec, in patients with irritable bowel syndrome: a multicenter, randomized study. J Clin Gastroenterol, 2008, 42 Suppl 3 Pt 2(8): S218-S223.
13. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
14. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
15. Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53(10): 2714-2718.
16. Williams EA, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther, 2008, 29(1): 97-103.
17. Agrawal A, Houghton LA, Morris J, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2009, 29(1): 104-114.
18. Hong KS, Kang HW, Im JP, et al. Effect of probiotics on symptoms in korean adults with irritable bowel syndrome. Gut Liver, 2009, 3(2): 101-107.
19. Simren M, Ohman L, Olsson J, et al. Clinical trial: the effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - a randomized, double-blind, controlled study. Aliment Pharmacol Ther, 2010, 31(2): 218-227.
20. Guglielmetti S, Mora D, Gschwender M, et al. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life - a double-blind, placebo-controlled study. Aliment Pharmacol Ther, 2011, 33(10): 1123-1132.
21. Hong YS, Hong KS, Park MH, et al. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45(5): 415-425.
22. Sondergaard B, Olsson J, Ohlson K, et al. Effects of probiotic fermented milk on symptoms and intestinal flora in patients with irritable bowel syndrome: a randomized, placebo-controlled trial. Scand J Gastroenterol, 2011, 46(6): 663-672.
23. Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther, 2011, 33(12): 1302-1310.
24. Aragon G, Graham DB, Borum M, et al. Probiotic therapy for irritable bowel syndrome. Gastroenterol Hepatol (NY), 2010, 6(1): 39-44.

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《中國循證醫學雜志》

益生菌治療腸易激綜合征隨機對照試驗的系統評價

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