益生菌治疗变应性鼻炎的临床疗效及抗变态反应作用Meta分析  

Therapeutic and anti-allergic effects of probiotics on allergic rhinitis:a meta-analysis

作　　者：林小燕 李静[1] 马志祺 李依琳 高馨怡 李勇[1] LIN Xiaoyan;LI Jing;MA Zhiqi;LI Yilin;GAO Xinyi;LI Yong(Affiliated Hangzhou First People̓s Hospital,Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院耳鼻咽喉科,浙江杭州310000

出　　处：《山东大学耳鼻喉眼学报》2021年第3期70-80,共11页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：浙江省医药卫生项目(2016KYB227);杭州市医药卫生项目(2017A10);浙江省医药卫生青年人才项目(2019RC066)。

摘　　要：目的系统性评价益生菌对变应性鼻炎的疗效及抗变态反应作用的影响。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方和维普数据库,收集以益生菌为干预措施治疗变应性鼻炎的随机对照试验(RCT),检索时限从建库截至2020年3月。由2名研究者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量,并采用RevMan5.3软件进行Meta分析。结果总共纳入27个RCT,共2147例患者,其中试验组1106例,对照组1041例。Meta分析结果显示:长期口服益生菌(≥12周)可以降低过敏性鼻炎患者血清总IgE水平[SMD=-0.22,95%CI(-0.42,-0.02),P=0.03<0.05]及血嗜酸性粒细胞水平[SMD=-0.38,95%CI(-0.69,-0.08),P=0.01<0.05];且益生菌组的鼻部RQLQ[MD=-0.78,95%CI(-0.96,-0.61),P<0.00001]、眼部RQLQ评分[MD=-0.75,95%CI(-0.90,-0.60),P<0.001]、TNSS评分[MD=-1.54,95%CI(-1.77,-1.31),P<0.001]及药物使用评分[SMD=-0.43,95%CI(-0.64,-0.22),P<0.00001]均较安慰组较低,差异有统计学意义。但益生菌组较安慰剂组在降低血清特异性IgE水平[SMD=0.08,95%CI(-0.11,0.26),P=0.42]及调节Th1/Th2平衡[SMD=0.40,95%CI(-1.20,1.99),P=0.63]方面差异无统计学意义。结论口服益生菌可以有效的控制变应性鼻炎患者的过敏症状,虽然短期内口服益生菌对AR的发生无明显预防作用,但长期服用可以降低血清总IgE水平及嗜酸性粒细胞计数水平,证明长期口服益生菌可能是治疗变应性鼻炎的一种疗效和安全性较为理想的辅助治疗手段。Objective To systemically review the therapeutic and anti-allergic effects of probiotics on allergic rhinitis(AR).Methods Publications from PubMed,the Cochrane Library,Embase,CNKI,WanFang,and VIP databases were searched from inception to February 2020.Two reviewers extracted the data and performed literature evaluation.Revman 5.3 software was used for meta-analysis.Results A total of 27 randomized controlled trials comprising 2147 patients(1106 patients in the probiotics group and 1041 patients in the placebo group)were included.The results of meta-analysis showed that probiotics reduced serum total IgE[SMD=-0.22,95%CI(-0.42,-0.02),P=0.03<0.05]and eosinophil level[SMD=-0.38,95%CI(-0.69,-0.08),P=0.01<0.05].Rhinoconjunctivitis quality of life questionnaire(RQLQ)nose symptoms[MD=-0.78,95%CI(-0.96,-0.61),P<0.001],RQLQ eye symptoms[MD=-0.78,95%CI(-0.96,-0.61),P<0.00001],the total nasal symptom score[MD=-1.54,95%CI(-1.77,-1.31),P<0.001],and medication scores[SMD=-0.43,95%CI(-0.64,-0.22),P<0.001]were significantly lower in the placebo group.However,specific IgE[SMD=0.08,95%CI(-0.11,0.26),P=0.42]and Th1/Th2 ratio[SMD=0.40,95%CI(-1.20,1.99),P=0.63]were not statistically different between the groups.Conclusion Probiotics effectively reduced symptom scores of patients with AR compared with placebo.Although short-term use of probiotics showed no significant preventive effects on AR,their long-term use reduced serum total IgE level and eosinophil count.Taken together,probiotics can be suggested as an effective treatment for AR.

关 键 词：益生菌 变应性鼻炎 随机对照实验 疗效 IgE TH1/TH2 嗜酸性粒细胞 META分析 

分 类 号：R765[医药卫生—耳鼻咽喉科]