微生态制剂治疗轻微肝性脑病的有效性及安全性分析  

Efficacy and safety of microecological preparations in treatment of minimal hepatic encephalopathy

作　　者：李变玲 黄会芳[1] 王晓阳 严微 LI Bian-ling;HUANG Hui-fang;WANG Xiao-yang;YAN Wei(Department of Gastroenterology,the First Hospital of Shanxi Medical University,Taiyuan,Shanri030000,China;不详)

机构地区：[1]山西医科大学第一医院消化内科,山西太原030000 [2]山西医科大学

出　　处：《中国微生态学杂志》2022年第7期759-767,773,共10页Chinese Journal of Microecology

基　　金：山西省面上自然科学基金(201901D111357)。

摘　　要：目的评价微生态制剂治疗轻度肝性脑病(MHE)的有效性及安全性。方法检索自建库至2020年9月在中国知网、万方数据知识服务平台、维普、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library等数据库收录的关于微生态制剂治疗MHE的临床随机对照试验。结果共纳入21篇文献,包括1543例患者。结果显示,2组研究对象比较,微生态制剂能提高双歧杆菌、乳杆菌水平,差异有统计学意义[MD=1.82,95%CI(1.19,2.44),Z=5.70,P<0.0001,MD=1.74,95%CI(0.95,2.54),Z=4.30,P<0.0001],降低肠杆菌水平[MD=-1.27,95%CI(-1.97,-0.57),Z=3.55,P=0.0004],而肠球菌水平差异无统计学意义(P>0.0500),2组研究对象比较,微生态制剂可显著降低血氨水平、ET水平[SMD=-0.83,95%CI(-1.08,-0.58),Z=6.43,P<0.0001,MD=-0.08,95%CI(-0.14,-0.01),Z=2.35,P=0.0200],2组研究对象比较,微生态制剂可显著降低数字连接试验A(NCT-A)用时[MD=-16.46,95%CI(-21.33,-11.59),Z=6.63,P<0.0001],而数字符号试验(DST)差异无统计学意义(P>0.0500),2组研究对象比较,微生态制剂可降低终末期肝病模型评分(MELD)、Child-Pugh评分、OHE发生率[MD=-2.41,95%CI(-3.87,-0.95),Z=3.24,P=0.0010,MD=-1.54,95%CI(-1.92,-1.16),Z=7.95,P<0.0001,OR=0.32,95%CI(0.20,0.52),Z=4.66,P<0.0001],并显著提高临床有效率[OR=4.95,95%CI(2.48,9.86),Z=4.55,P<0.0001],但不会增加不良反应[OR=0.48,95%CI(0.12,1.91),Z=1.04,P=0.3000]。结论微生态制剂可基于调节肠道菌群平衡有效改善MHE,可防止OHE的发生,且安全性好,有望成为治疗MHE的最新选择。Objective To evaluate the efficacy and safety of microecological preparations in the treatment of minimal hepatic encephalopathy(MHE). Methods Clinical randomized controlled trials(RCTs) on microecological preparations in the treatment of MHE from inception to September 2020 were retrieved from CNKI, WanFang Data Knowledge Service Platform, VIP, China Biomedical Literature Service System, PubMed, Web of Science, Embase, Cochrane Library and other databases. Results A total of 21 studies were included, involving 1,543 patients. The results showed that the levels of Bifidobacterium and Lactobacillus could be increased by microecological preparation. The difference was statistically significant [MD=1.82, 95% CI(1.19, 2.44), Z=5.70, P<0.000 1;MD=1.74, 95% CI(0.95, 2.54), Z=4.30, P<0.000 1]. The level of Enterobacteria was decreased [MD=-1.27, 95% CI(-1.97,-0.57), Z=3.55, P=0.000 4], but that of Enterococcus was not statistically significant between two groups(P>0.050 0). Compared with the control group, the levels of blood ammonia and ET were significantly reduced by microecological preparation [SMD=-0.83, 95% CI(-1.08,-0.58), Z=6.43, P<0.000 1;MD=-0.08, 95% CI(-0.14,-0.01), Z=2.35, P=0.020 0]. Compared with the control group, microecological preparations could significantly reduce the duration of digital connection test A(NCT-A) [MD=-16.46, 95% CI(-21.33,-11.59), Z=6.63, P<0.000 1], but there was no statistical significance in digital symbol test(DST)(P>0.050 0). Comparison between the two groups showed that microecological preparations could decrease the model for end-stage liver disease(MELD) score, Child-Pugh score and the incidence of OHE [MD=-2.41, 95% CI(-3.87,-0.95), Z=3.24, P=0.001 0;MD=-1.54, 95% CI(-1.92,-1.16), Z=7.95, P<0.000 1;OR=0.32, 95% CI(0.20, 0.52), Z=4.66, P<0.000 1], and significantly improve the clinical efficiency [OR=4.95, 95% CI(2.48, 9.86), Z=4.55, P<0.000 1], while did not increase adverse reactions [OR=0.48, 95% CI(0.12, 1.91), Z=1.04, P=0.300 0]. Conclusion Microecological preparations c

关 键 词：轻微肝性脑病 微生态制剂 荟萃分析 

分 类 号：R575.2[医药卫生—消化系统]