益生菌预防和治疗支气管哮喘的系统评价_《中国循证医学杂志》

作者：

何敏 ¹ , 王婷 ¹ , 张红萍 ² , 贾春娥 ² , 熊星宇 ¹ , 王刚 ² ,  姬郁林 ¹

1. 四川大学华西医院呼吸内科（成都 610041）；2. 四川大学华西医院中西医结合科呼吸组（成都 610041）;

关键词：

益生菌预防治疗支气管哮喘系统评价 Meta分析

DOI：

10.7507/1672-2531.20120072

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价益生菌（合生元）对预防和治疗支气管哮喘（简称哮喘）的疗效和安全性。
方法　计算机检索PubMed、EMbase、Web of Science、OVID和Cochrane图书馆等电子数据库，检索时限从建库至2011年8月，查找益生菌预防或治疗哮喘患者的随机对照试验（RCT）。对符合条件的RCT，由两位评价员独立进行资料提取、质量评价并交叉核对后，采用RevMan 5.1软件进行Meta分析。
结果　共纳入益生菌预防哮喘的RCT 11个（n=3 656），益生菌治疗哮喘的RCT 5个（n=430）。预防性研究Meta分析结果显示，与安慰剂比较，益生菌在预防哮喘［RR=0.76，95%CI（0.47， 1.22），P=0.25］和喘息发生［RR=0.92，95%CI（0.62， 1.39），P=0.71］方面，差异无统计学意义。治疗性研究Meta分析结果显示，与安慰剂比较，益生菌能延长哮喘无症状持续时间［RR=1.48，95%CI（1.20， 1.76），P lt;0.000 1］。所有的RCT均无严重不良事件报道。
结论　现有证据尚不足以支持益生菌对哮喘的发生有预防作用，但益生菌治疗可能延长儿童哮喘无症状持续时间，在一定程度可能具有改善肺功能的作用，但不能减少哮喘的急性发作，且亦未在改善免疫功能方面显示优势。

引用本文： 何敏,王婷,张红萍,贾春娥,熊星宇,王刚,姬郁林. 益生菌预防和治疗支气管哮喘的系统评价. 中国循证医学杂志, 2012, 12(4): 460-469. doi: 10.7507/1672-2531.20120072 复制

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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.
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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.

《中国循证医学杂志》

益生菌预防和治疗支气管哮喘的系统评价

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《中国循证医学杂志》

益生菌预防和治疗支气管哮喘的系统评价

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