摘要
目的:系统评价益生菌在预防和治疗化疗性腹泻(chemotherapy-induced diarrhea,CID)中的安全性和有效性,为临床实践提供循证依据.方法:检索包括EMbase、Cochrane图书馆、PubMed、中国知网、维普数据库、中国生物医学文献数据库和万方数据库在内的电子数据库,搜索截至2023年9月31日接受益生菌治疗的CID的随机对照试验(randomized controlled trial,RCT).使用RevMan 5.1统计软件提取数据并评估所鉴定文献的质量以进行meta分析.结果:共纳入包括1 032例患者的13项RCT.研究结果提示,止泻等常规对症疗法联合益生菌制剂可显著降低化疗期间的总腹泻率(OR=0.33,95％CI:0.21～0.51,P＜0.001)和Ⅲ～Ⅳ级腹泻率(OR=0.12,95％CI:0.04～0.39,P＜0.001),进而提升总有效率(OR=4.26,95％CI:2.55～7.12,P＜0.001),并缩短腹泻持续时间(MD=-1.92,95％CI:-1.96～-1.88,P＜0.001),但在Ⅰ～Ⅱ级腹泻患者中差异无统计学意义(OR=0.73,95％CI:0.39～1.38,P=0.330).同时,没有一项研究报告有不良反应发生.结论:预防性或同时在化疗期间应用益生菌制剂可有效防治肿瘤患者发生CID,安全性良好.
Abstract
Objective:To systematically evaluate the safety and efficacy of probiotics in preventing and treating chemotherapy-induced diarrhea(CID),so as to provide the evidence-based evidence for clinical practice.Methods:Electronic databases,including EMbase,Cochrane Library,PubMed,CNKI,CBM,VIP and Wanfang databases,were retrieved to search for the randomized controlled trial(RCT)of CID among patients with malignant tumors treated with probiotics as of September 31,2023.Later,the RevMan 5.1 statistical software was employed to ex-tract data and assess the quality of the identified literature for meta-analysis.Results:Thirteen RCT involving a total of 1 032 patients were included into the current meta-analysis.Results of this meta-analysis suggested that conventional symptomatic therapy combined with probiotics could significantly reduce the total diarrhea rate in tumor patients(OR=0.33,95％CI:0.21-0.51,P＜0.001)and grade Ⅲ-Ⅳ diarrhea(OR=0.12,95％CI:0.04-0.39,P＜0.001),increase the total effective rate(OR=4.26,95％CI:2.55-7.12,P＜0.001),and shorten the duration of diarrhea(MD=-1.92,95％CI:-1.96--1.88,P＜0.001),with significant differ-ence.But among patients with grade Ⅰ-Ⅱ diarrhea(OR=0.73,95％CI:0.39-1.38,P=0.330),the differ-ence was not statistically significant.Besides,none of the enrolled study had reported adverse reactions.Conclu-sion:Probiotics can prevent and treat CID of tumor patients effectively during chemotherapy,with less adverse e-vents.
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