孕期及婴幼儿期补充益生菌预防儿童过敏性湿疹效果的Meta分析

黄腊芳; 何珍; 殷道根; 王庆川; 廖小兵; 段学燕

doi:10.11852/zgetbjzz2018-26-08-17

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中国儿童保健杂志 ›› 2018, Vol. 26 ›› Issue (8) : 873-877. DOI: 10.11852/zgetbjzz2018-26-08-17

荟萃分析

孕期及婴幼儿期补充益生菌预防儿童过敏性湿疹效果的Meta分析

黄腊芳, 何珍, 殷道根, 王庆川, 廖小兵, 段学燕

作者信息 +

Meta-analysis of the effect of probiotics supplementation during pregnancy and early infancy on preventing children eczema

HUANG La-fang, HE Zhen,YIN Dao-gen,WANG Qing-chuan, LIAO Xiao-bing, DUAN Xue-yan

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文章历史 +

摘要

目的系统评价补充益生菌对儿童过敏性湿疹的预防效果。方法运用Rev Man 5.3软件,对2000年以来国内外发表的有关益生菌预防儿童过敏性湿疹的随机对照试验研究进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型,计算RR值及95%CI,评估发表偏倚,进行敏感性分析,并按干预菌株不同及随访时间点不同进行亚组分析。结果最终纳入23篇文献,累计干预组3 004例,对照组3 016例。合并效应量结果显示,益生菌预防儿童过敏性湿疹的合并RR值为0.76(95%CI:0.65~0.89)(P＜0.05);亚组分析结果显示,使用混合菌株干预效果显著(RR＝0.56,95%CI:0.41~0.78)(P＜0.05),随访时间≤12个月及≤24个月所得结果表明益生菌预防儿童过敏性湿疹效果显著(P＜0.05),合并RR值分别为0.69(95%CI:0.51~0.93)和0.77(95%CI:0.60~0.98)。结论应提倡孕期及婴幼儿期补充益生菌,推荐使用乳酸杆菌和双歧杆菌混合菌株,预防儿童过敏性湿疹。

Abstract

Objective To evaluate the effect of probiotics supplementation on preventing children eczema systematically. Methods Randomized controlled trial studies regarding the effect of probiotics supplementation during pregnancy and early infancy on preventing children eczema since 2000 were analyzed by Meta-analysis with Rev Man 5.3 software.The fixed effect model or random effect model was selected by the heterogeneity test results.The RR value and 95%CI were calculated,publication bias was evaluated, and sensitivity analysis was conducted.Subgroup analysis was conducted according to different strains and different end time of follow-up. Results Totally 23 published articles were selected, including 3 004 intervention cases and 3 016 control cases.The RR and 95%CI of probiotics supplementation preventing children eczema was 0.76(95%CI:0.65~0.89) (P＜0.05);Subgroup analysis revealed that the RR and 95%CI of probiotic mixtures was 0.56(95%CI:0.41~0.78)(P＜0.05);The end time of follow-up for≤12 months and ≤24 months were 0.69(95%CI:0.51~0.93) (P＜0.05) and 0.77(95%CI:0.60~0.98) (P＜0.05), respectively. Conclusions In order to prevent children atopic eczema, probiotics supplementation during pregnancy and early infancy should be promoted.Moreover, probiotic mixtures with Lactobacillus and Bifidobacterium are the best choice.

导出引用

黄腊芳, 何珍, 殷道根, 王庆川, 廖小兵, 段学燕. 孕期及婴幼儿期补充益生菌预防儿童过敏性湿疹效果的Meta分析[J]. 中国儿童保健杂志. 2018, 26(8): 873-877 https://doi.org/10.11852/zgetbjzz2018-26-08-17

HUANG La-fang, HE Zhen,YIN Dao-gen,WANG Qing-chuan, LIAO Xiao-bing, DUAN Xue-yan. Meta-analysis of the effect of probiotics supplementation during pregnancy and early infancy on preventing children eczema[J]. Chinese Journal of Child Health Care. 2018, 26(8): 873-877 https://doi.org/10.11852/zgetbjzz2018-26-08-17

中图分类号： R179

参考文献

[1] Koet LB, Brand PL.Increase in atopic sensitization rate among Dutch children with symptoms of allergic disease between 1994 and 2014[J].Pediatr Allergy Immunol, 2017, 29(1):78-83.
[2] Ou CY, Kuo HC, Wang L, et al.Prenatal and postnatal probiotics reduces maternal but not childhood allergic diseases:a randomized, double-blind, placebo-controlled trial[J].Clin Exp Allergy 2012, 42(9):1386-1396.
[3] West CE, Jenmalm MC, Prescott SL.The gut microbiota and its role in the development of allergic disease:a wider perspective[J].Clin Exp Allergy, 2015, 45(1):43-53.
[4] 曾燕, 刘小芸, 邓全敏.饮食干预对高过敏风险婴儿过敏预防的疗效观察[J].中国儿童保健杂志, 2015, 23(7):756-759.
[5] 曾宪涛,包翠萍,曹世义,等.Meta 分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志,2012,4(3):183-185.
[6] Zuccotti G, Meneghin F, Aceti A, et al.Probiotics for prevention of atopic diseases in infants:systematic review and meta-analysis[J].Allergy, 2015, 70(11):1356-1371.
[7] Abrahamsson TR, Jakobsson T, Bjorksten B, et al.No effect of probiotics on respiratory allergies:a sevenyear follow-up of a randomized controlled trial in infancy[J].Pediatr Allergy Immunol, 2013, 24(6):556-561.
[8] Abrahamsson TR, Jakobsson T, Bottcher MF, 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.
[9] Bottcher MF, Abrahamsson TR, Fredrikson M, et al.Low breast milk TGF-beta2 is induced by Lactobacillus reuteri supplementation and associates with reduced risk of sensitization during infancy[J].Pediatr Allergy Immunol, 2008, 19(6):497-504.
[10] Boyle RJ, Ismail IH, Kivivuori S, et al.Lactobacillus GG treatment during pregnancy for the prevention of eczema:a randomized controlled trial[J].Allergy, 2011, 66(4):509-516.
[11] Huurre A, Laitinen K, Rautava S, et al.Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization:a doubleblind placebo-controlled study[J].Clin Exp Allergy 2008, 38(8):1342-1348.
[12] Kalliomaki M, Salminen S, Arvilommi H, et al.Probiotics in primary prevention of atopic disease:a randomised placebo-controlled trial[J].Lancet, 2001, 7(3):1076-1079.
[13] Kim JY, Kwon JH, Ahn SH, et al.Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema:a double-blind, randomized, placebo-controlled trial[J].Pediatr Allergy Immunol, 2010, 21(22):386-393.
[14] Kopp MV, Hennemuth I, Heinzmann A, et al.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.
[15] Niers L, Martin R, Rijkers G, et al.The effects of selected probiotic strains on the development of eczema (the PandA study)[J].Allergy, 2009, 64(9):1349-1358.
[16] Prescott SL, Wiltschut J, Taylor A, et al.Early markers of allergic disease in a primary prevention study using probiotics:2.5-year follow-up phase[J].Allergy, 2008, 63(11):1481-1490.
[17] Rautava S, Kainonen E, Salminen S, et al.Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant[J].J Allergy Clin Immunol, 2012, 130(6):1355-1360.
[18] Rautava S, Kalliomaki M, Isolauri E.Probiotics during pregnancy and breastfeeding might confer immunomodulatory protection against atopic disease in the infant[J].J Allergy Clin Immunol, 2002, 109(1):119-121.
[19] 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.
[20] Wickens K, Black P, Stanley TV, et al.A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years[J].Clin Exp Allergy, 2012, 42(7):1071-1079.
[21] Wickens K, Black PN, Stanley TV, 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.
[22] Wickens K, Stanley TV, Mitchell EA, et al.Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years:does it also reduce atopic sensitization?[J].Clin Exp Allergy, 2013, 43(9):1048-1057.
[23] 吴福玲, 冯学斌, 刘秀香, 等.双歧杆菌对母乳成分的影响及其与婴儿过敏性疾病的关系[J].临床儿科杂志, 2010, 28(3):260-263.
[24] 冷丽.益生菌在婴儿湿疹临床一级预防中的作用[J].中外医学研究, 2011, 9(10):78.
[25] 宋舜意, 王桂芳, 赵卫东, 等.益生菌对婴幼儿湿疹的预防作用观察[J].中国微生物学杂志, 2005, 17(4):316.
[26] Allen SJ, Jordan S, Storey M, et al.Probiotics in the prevention of eczema:a randomised controlled trial[J].Archives of Disease in Childhood, 2014, 99(11):1014-1019.
[27] Cabana MD, Mckean M, Caughey AB, et al.Early probiotic supplementation for eczema and asthma prevention:a randomized controlled trial[J].Pediatircs, 2017, 140(3):1-9.
[28] 唐鲁静, 陈洁, 沈毅.益生菌预防儿童过敏性疾病的Meta分析[J].中华儿科杂志, 2012, 50(7):504-509.
[29] 郑跃杰.益生菌在儿童过敏性疾病的应用[J].中国实用儿科杂志, 2017, 32(2):114-117.
[30] 何心, 张永, 许静, 等.预防儿童抗生素相关性腹泻的益生菌随机对照试验meta分析[J].中华医院感染学杂志, 2017, 27(1):185-189.
[31] 孙中厚, 李晓莉, 武帆, 等.潍坊地区过敏性鼻炎和支气管哮喘患儿过敏原检测结果分析[J].中国儿童保健杂志, 2016, 24(2):198-201.
[32] 周佳,许正浩, 赵华伟.益生菌预防婴幼儿湿疹复发作用的Meta分析[J].海峡药学, 2016, 28(6):152-154.
[33] 单延春, 冯雪英, 衣明纪.食物过敏儿童的生长状况与营养管理[J].中国儿童保健杂志, 2016, 24(10):1055-1058.
[34] 夏利平, 姜毅.益生菌在儿童变态反应性疾病中的防治作用[J].中国当代儿科杂志, 2016, 18(2):189-194.
[35] 高琦, 向莉, 申昆玲.儿童过敏进程及其防治研究进展[J].中国儿童保健杂志, 2014, 22(11):1168-1170.