益生菌/合生元能否改善脂肪肝?
  • 纳入共1252位非酒精性脂肪肝(NAFLD)患者参与的21项RCT(9项益生菌和12项合生制剂,干预8-28周)进行荟萃分析;
  • 益生菌/合生制剂与丙氨酸氨基转移酶(ALT)活性和肝脏硬度(反映炎症和纤维化)显著降低相关;
  • 根据超声分级,益生菌/合生制剂与改善肝脂肪变性的几率增加有关;
  • 益生菌而非合生制剂与体重指数显著下降有关;
  • 益生菌/合生制剂可改善NAFLD患者肝脏炎症/硬度和脂肪变性,由于结果存在异质性,需更多随机对照试验来验证。
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American Journal of Clinical Nutrition上发表的一项荟萃分析结果,在21项RCT(超过1200名患者)中发现,益生菌或合生制剂治疗与NAFLD患者症状的改善相关。
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Gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review, meta-analysis, and meta-regression

靶向肠道菌群治疗非酒精性脂肪肝:一项系统回顾、荟萃分析和荟萃回归

10.1093/ajcn/nqz042

2019-05-24, Review

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Abstract:收起
BACKGROUND: Preclinical evidence suggests that modulation of the gut microbiome could represent a new therapeutic target in nonalcoholic fatty liver disease (NAFLD).
OBJECTIVES: The aim of this study was to evaluate the most current evidence for liver-specific and metabolic effects of microbiome-targeted therapies (MTTs) in persons with NAFLD.
METHODS: We searched multiple electronic databases for randomized controlled trials (RCTs) published from January 1, 2005 to December 1, 2018 that enrolled persons with NAFLD who received MTT rather than placebo or usual care. MTT was defined as antibiotics, probiotics, synbiotics, or fecal microbiota transplantation (FMT). Clinical outcomes were pooled with the use of random-effects models and heterogeneity was assessed with the I2 statistic. A random-effects meta-regression was performed to determine sources of heterogeneity in prevalence estimates between studies.
RESULTS: Twenty-one RCTs (1252 participants) were included; 9 evaluated probiotics and 12 evaluated synbiotics, with treatment duration ranging from 8 to 28 wk. No RCTs examined the efficacy of antibiotics or FMT. Probiotics/synbiotics were associated with a significant reduction in alanine aminotransferase activity [ALT, weighted mean difference (WMD): -11.23 IU/L; 95% CI: -15.02, -7.44 IU/L] and liver stiffness measurement (LSM) by elastography (reflecting inflammation and fibrosis) (WMD: -0.70 kPa; 95% CI: -1.00, -0.40 kPa), although analyses showed heterogeneity (I2 = 90.6% and I2 = 93.4%, respectively). Probiotics/synbiotics were also associated with increased odds of improvement in hepatic steatosis, as graded by ultrasound (OR: 2.40; 95% CI: 1.50, 3.84; I2 = 22.4%). No RCTs examined sequential liver biopsy findings. Probiotics (WMD: -1.84; 95% CI: -3.30, -0.38; I2 = 23.6%), but not synbiotics (WMD: -0.85; 95% CI: -2.17, 0.47; I2 = 96.6%), were associated with a significant reduction in body mass index.
CONCLUSIONS: The use of probiotics/synbiotics was associated with improvement in liver-specific markers of hepatic inflammation, LSM, and steatosis in persons with NAFLD. Although promising, given the heterogeneity in pooled analyses, additional well-designed RCTs are needed to define the efficacy of probiotics/synbiotics for treatment of NAFLD. This study was registered with PROSPERO as CRD42018091455.

First Authors:
Suzanne R Sharpton

Correspondence Authors:
Norah A Terrault

All Authors:
Suzanne R Sharpton,Bharat Maraj,Emily Harding-Theobald,Eric Vittinghoff,Norah A Terrault

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