Efficacy and safety of probiotics in the treatment of nonalcoholic fatty liver disease:a meta-analysis
OBJECTIVE To systematically evaluate the efficacy and safety of probiotics in the treatment of nonalcoholic fatty liver disease(NAFLD).METHODS Retrieved from CNKI,Wanfang data,VIP,SinoMed,PubMed,Embase,Web of Science,Cochrane library databases,the published randomized controlled trials(RCTs)about probiotics(treatment group)versus placebo or healthy lifestyle(control group)in the treatment of NAFLD were collected from the inception to Oct.10th,2023.The quality of the included literature was evaluated and rated by Cochrane system evaluator manual 5.1.0 and GRADE tools.Meta-analysis and Egger's test were carried out by using RevMan 5.4 and Stata 17.0 software.RESULTS Overall 24 RCTs were included in this study,involving 1 391 patients with NAFLD.Meta-analysis showed that compared with control group,the levels of alanine aminotransferase[MD=-6.29,95%CI(-9.35,-3.22),P＜0.000 1],aspartate aminotransferase[MD=-4.89,95%CI(-7.55,-2.23),P=0.000 3]and γ-glutamyl transferase[MD=-4.87,95%CI(-6.54,-3.20),P＜0.000 01],the liver stiffness measurement[MD=-0.36,95%CI(-0.48,-0.24),P＜0.000 01],the levels of triglycerides[MD=-0.22,95%CI(-0.27,-0.16),P＜0.000 01],total cholesterol[MD=-0.34,95%CI(-0.44,-0.25),P＜0.000 01]and insulin resistance assessed by homeostasis model[MD=-0.38,95%CI(-0.63,-0.13),P=0.003]were all significantly decreased in the treatment group.However,there was no statistically significant difference of probiotics therapy in the levels of tumor necrosis factor-α[MD=-0.41,95%CI(-1.29,0.48),P=0.37],interleukin-6[MD=0.39,95%CI(-0.10,0.88),P=0.12],high-sensitivity C-reactive protein[MD=-0.30,95%CI(-0.85,0.25),P=0.28],high-density lipoprotein cholesterol[MD=0.03,95%CI(-0.01,0.06),P=0.10]and low-density lipoprotein cholesterol[MD=-0.10,95%CI(-0.27,0.07),P=0.23]and body mass index[MD=0.07,95%CI(-0.26,0.40),P=0.68].Subgroup analysis based on different intervention measures showed that the levels of γ-glutamyl transferase,liver stiffness measurement,and homeostatic model assessment of insulin resistance in the synbiotic group were not significantly improved compared to the control group,with consistent results for the remaining outcomes.Egger's test results showed no publication bias.CONCLUSIONS The probiotic therapy can regulate liver function indexes,liver stiffness measurement and insulin resistance levels in patients with NAFLD well.
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