益生菌预防成人艰难梭菌相关性腹泻的Meta分析

目的 系统评价益生菌预防成人艰难梭菌相关性腹泻（Clostridium difficile associated diarrhea，CDAD）的临床疗效。方法 计算机检索PubMed、EMBASE、Cochrane、Web of Science、CBM、万方数据库、维普资讯网和中国知网全文数据库，纳入益生菌预防成人CDAD的随机对照试验（RCT），采用随机效应模型进行Meta分析。结果 共有13项符合纳入标准的随机对照试验，包括5 179名患者，其中干预组2 730例，对照组2 449例。Meta分析结果显示，预防性使用益生菌可降低CDAD的风险（RR=0.49，95％CI 0.33‒0.75，I2=16.4％）。亚组分析发现益生菌高剂量（RR=0.41，95%CI 0.22‒0.77，P=0.043）、混合菌种（RR=0.43，95%CI 0.24‒0.75，P=0.037）与对照组相比，差异均有统计学意义。结论 辅助性益生菌的应用能够有效预防成人艰难梭菌相关性腹泻的发生。但受纳入研究数量较少与研究质量的参差不齐的影响，本结论尚需要开展更多高质量、大样本的研究予以证实。

A Meta-analysis: Probiotics for the prevention ofClostridium difficile associated diarrhea in adult people

Objective To systematically evaluate the efficacy of probiotics in preventing Clostridium difficile associated diarrhea (CDAD) in adult people. Methods Eight electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, CBM, CNKI, VIP, and WANFANG) were searched for the literatures regarding parallel randomized controlled trials (RCTs) on use of probiotics for prevention of CDAD. Meta-analysis was performed by using the random effects model. Results A total of 13 RCTs met the inclusion criteria, involving 5,179 patients who were in intervention group (2,730 cases) and control group (2,449 cases) respectively. Pooled analyses revealed that the prophylactic use of probiotics could reduce the morbidity risks of CDAD (RR=0.49, 95%CI 0.33 - 0.75, I2=16.4%). The subgroup analysis found statistically significant differences between the control group and high does subgroup (RR=0.41, 95%CI 0.22 - 0.77, P=0.043) and between the control group and multi-probiotics combination subgroup (RR=0.43, 95%CI 0.24 - 0.75, P=0.037). Conclusion The available clinical evidences suggest that probiotics as the adjuvant therapy is associated with a reduction in the occurrence of CDAD. However, this conclusion needs be further confirmed by more high-quality large-scale studies.