乳酸菌对婴幼儿湿疹一级预防的系统评价

朱帝玲; 杨文旭; 杨慧明

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中国当代儿科杂志 ›› 2010, Vol. 12 ›› Issue (09) : 734-739.

论著·临床研究

乳酸菌对婴幼儿湿疹一级预防的系统评价

朱帝玲，杨文旭，杨慧明

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Meta analysis of lactic acid bacteria as probiotics for the primary prevention of infantile eczema

ZHU Di-Ling, YANG Wen-Xu, YANG Hui-Ming

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摘要

目的：系统评价乳酸菌属益生菌对婴幼儿湿疹及特应性湿疹的一级预防作用。方法：检索相关数据库中(检索时间到2010年1月)使用乳酸菌预防≤2岁婴幼儿湿疹和（或）特应性湿疹的随机对照试验(RCT)，应用系统评价的方法进行质量评价，用 RevMan 5.0.2进行meta分析。结果：共纳入了报道乳酸菌对婴幼儿湿疹发病预防作用的RCT 12篇，其中7篇报道了对特应性湿疹的预防效果。Meta 分析示：与对照组比较，乳酸菌组（单用及与其他益生菌合用）湿疹及特应性湿疹的发病率显著降低，RR值分别为0.80（95%CI: 0.70~0.90，P<0.01），0.78（95%CI：0.64~0.97, P<0.01）。乳酸菌联合其他益生菌可显著减少湿疹发生，RR值为0.79（95%CI：0.68~0.93, P<0.01），而单独使用乳酸菌对湿疹无明显预防作用，其RR值为0.85（95%CI：0.69~1.05, P>0.05）。结论：乳酸菌联合其他益生菌可预防婴幼儿湿疹的发生。目前证据未显示单独使用乳酸菌对婴幼儿湿疹的有预防作用，有待大规模的多中心RCT研究予以明确。［中国当代儿科杂志，2010，12（9）：734-739］

Abstract

OBJECTIVE: To determine whether lactic acid bacteria as probiotics is efficacious in the primary prevention of infantile eczema or atopic eczema. METHODS: For this meta analysis of randomized controlled trials (RCT) describing the efficacy of probiotics in infants with eczema or atopic eczema at ages of ≤2 years, a comprehensive search in the databases was performed up to January 2010. Three reviewers independently evaluated the studies for methodological qualities. RevMan 5.0.2 software was used for meta analysis. RESULTS: Twelve RCTs on the preventive effects of lactic acid bacteria as probiotics on infantile eczema were included, and 7 of the 12 RCTs reported the preventive effect of lactic acid bacteria on atopic eczema. The meta analysis showed that there was an overall significant reduction in infantile eczema and atopic eczema favoring lactic acid bacteria compared with placebo. The relative risk (RR) ratios for eczema and atopic eczema were 0.80 (95%CI: 0.70-0.90; P<0.01) and 0.78 (95%CI: 0.64-0.97; P<0.01), respectively. Lactic acid bacteria combined with other probiotics decreased significantly the incidence of eczema, with a RR ratio of 0.79 (95%CI: 0.68-0.93; P<0.01). The use of lactic acid bacteria alone did not result in a reduction in the incidence of eczema, with a RR ratio of 0.85 (95%CI: 0.69-1.05; P>0.05). CONCLUSIONS: The data from this meta analysis suggest that lactic acid probiotics combined with other probiotics play a role in the prevention of infantile eczema. There is insufficient evidence to recommend single use of lactic acid bacteria for prevention of eczema. Further studies are required to determine whether the findings are reproducible.［Chin J Contemp Pediatr, 2010, 12 (9):734-739］

导出引用

朱帝玲, 杨文旭, 杨慧明. 乳酸菌对婴幼儿湿疹一级预防的系统评价[J]. 中国当代儿科杂志. 2010, 12(09): 734-739

ZHU Di-Ling, YANG Wen-Xu, YANG Hui-Ming. Meta analysis of lactic acid bacteria as probiotics for the primary prevention of infantile eczema[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(09): 734-739

中图分类号： R729

参考文献

［1］Lehtonen EP，HolmbergMarttila D，Kaila　M．Cumulative prevalence of atopic eczema and related skin symptoms in a wellbaby clinic：a retrospective cohort study［J］．Pediatr Allergy Immunol，2003，14 (5)：405408．
［2］Daniels J，Harper J．The epidemiology of　atopic dermatitis［J］．Hosp Med， 2002， 63 (11)：649652．
［3］杜颖，丛衍群，戴宁，译．世界胃肠组织临床指南益生菌与益生元［DB/OL］. ［20100208］. http://www.worldgastroenterology.org/assets/downloads/cn/pdf/guidelines/19_probiotics_prebiotics_cn.pdf．
［4］Borchers AT， Selmi C， Meyers FJ， Keen CL， Gershwin ME． Probiotics and immunity［J］． J Gastroenterol, 2009， 44(1)：2646．
［5］Higgins JPT，Green S．Cochrane Handbook for Systematic Reviews of Interventions Version 5．0．2［DB/OL］．［updated September 2009］. The Cochrane Collaboration， 2008． Available from www．cochranehandbook．org．
［6］Review Manager (RevMan) ［Computer program］．Version 5．0．Copenhagen： The Nordic Cochrane Centre，The Cochrane Collaboration，2008．
［7］Kalliomki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomisedplacebocontrolled trial［J］.Lancet，2001，357(9262)：10761079．
［8］Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breastfeeding might confer immunomodulatory protection against atopic disease in the infant［J］. J Allergy Clin Immunol, 2002, 109（1）:119121.
［9］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［J］． J Allergy Clin Immunol， 2007， 119(1)：184191．
［10］Abrahamsson TR， Jakobsson T， Bottcher MF， Fredrikson M， Jenmalm MC， Bjrkstén B，et al． Probiotics in prevention of IgEassociated eczema： a doubleblind， randomized， placebocontrolled trial［J］． J Allergy Clin Immunol， 2007， 119(5)：11741180．
［11］Kukkonen K， Savilahti E， Haahtela T， JuntunenBackman K， Korpela R， Poussa T， et al．Probiotics and prebiotic galactooligosaccharides in the prevention of allergic diseases： a randomized， doubleblind， placebocontrolled trial［J］． J Allergy Clin Immunol， 2007， 119(1)：192198．
［12］Kopp MV, Hennemuth I, Heinzmann A, Urbanek R. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of Lactobacillus GG supplementation［J］. Pediatrics, 2008, 121(4): 850-856．
［13］West CE, Hammarstr-m ML, Hernell O. Probiotics during weaning reduce the incidence of eczema［J］. Pediatr Allergy Immunol, 2009, 20(5): 430-437.
［14］Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YP, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants-effects on eczema and atopic sensitization at the age of 1 year［J］. Clin Exp Allergy, 2009, 39(4)：571-578．
［15］Wickens K, Black PN, Stanley TV, Mitchell E, Fitzharris P, Tannock GW, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebocontrolled trial［J］. J Allergy Clin Immunol, 2008, 122(4): 788-794.
［16］Niers L, Martin R, Rijkers G, Sengers F, Timmerman H, van Uden N, et al. The effects of selected probiotic strains on he development of eczema (the PandA study)［J］. Allergy, 2009, 64(9): 1349-1358．
［17］Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E．Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double-blind placebo-controlled study［J］. Clin Exp Allergy, 2008, 38（8）:1342-1348．
［18］Rautava S, Arvilommi H, Isolauri E. Specific probiotics in enhancing maturation of IgA responses in formula-fed infants［J］. Pediatr Res， 2006, 60 (2): 221-224．
［19］Kopp MV, Goldstein M, Dietschek A, Sofke J, Heinzmann A, Urbanek R. Lactobacillus GG has in-vitro effects on enhanced IL-10 and IFN-y release of mononuclear cells but no in-vivo effects in supplemented mothers and their neonates［J］.Clin Exp Allergy, 2008, 38(4): 602-610.
［20］Nonaka Y, Izumo T, Izumi F, Maekawa T, Shibata H, Nakano A, et al. Antiallergic effects of Lactobacillus pentosus strain S-PT84 mediated by modulation of Th1/Th2 immunobalance and induction of IL-10 production［J］. Int Arch Allergy Immunol, 2008, 145(3): 249-257.