补充益生菌对2型糖尿病患者糖代谢改善的meta分析

doi:10.3969/j.issn.1004-583X.2023.07.001

摘要/Abstract

摘要：

目的评价益生菌对2型糖尿病患者糖代谢的影响,并阐述其作用机制,为临床诊治提供思路与方法。方法通过对PubMed、Embase、Web of science、中国知网、万方数据知识服务平台和维普中文科技期刊数据库进行检索,检索时间节点为2022年11月31日之前的随机对照试验,所有文献检索由两名研究者独立完成,并对纳入文献进行评价、提取资料后,将最终纳入的文献使用RevMan 5.4软件进行meta分析。结果共纳入11篇文献,共有709名患者纳入研究,其中干预组人数为371名,对照组人数为338名。Meta分析结果显示:与对照组相比,益生菌可显著降低2型糖尿病患者空腹血糖、糖化血红蛋白、稳态模型评估的胰岛素抵抗指数及空腹胰岛素水平。结论补充益生菌可改善2型糖尿病患者的糖代谢,可将益生菌作为2型糖尿病患者的辅助治疗之一。

关键词: 糖尿病, 2型, 糖代谢, 益生菌, meta分析

Abstract:

Objective To evaluate the effect of probiotics on glucose metabolism in patients with type 2 diabetes mellitus (T2DM), and to elaborate its mechanism of action, so as to provide ideas and approaches for clinical diagnosis and treatment of T2DM. Methods Randomized controlled trials (RCTs) reporting the effect of probiotics on glucose metabolism in T2DM patients published before 31^st November 2022 were searched in the online databases of PubMed, Embase, Web of science, CNKI, Wanfang Data Knowledge Service Platform and CQVIP database were searched. Two investigators were independently responsible for literature screening. The included literatures were assessed and data were extracted and analyzed using RevMan 5.4 software. Results A total of 11 studies were included in the study, involving 709 T2DM patients. There were 371 T2DM patients in the experimental group and 338 in the control group. Meta-analysis showed that probiotic supplementation significantly reduced fasting plasma glucose (FPG), hemoglobin A1C (HbA₁C), homeostatic model assessment for insulin resistance (HOMA-IR), and fasting insulin levels in the experimental group than those in the control group. Conclusion Probiotic supplementation can improve glucose metabolism in T2DM patients, and probiotics can be used as one of the adjuvant treatments for T2DM patients.

Key words: diabetes mellitus, type 2, glucose metabolism, probiotics, meta-analysis

中图分类号:

R587.1

金家辉, 杨阳, 秦铜, 何雨欣, 苏美华. 补充益生菌对2型糖尿病患者糖代谢改善的meta分析[J]. 临床荟萃, 2023, 38(7): 581-587.

Jin Jiahui, Yang Yang, Qin Tong, He Yuxin, Su Meihua. Probiotic supplementation on improving glucose metabolism in patients with type 2 diabetes mellitus: A meta-analysis[J]. Clinical Focus, 2023, 38(7): 581-587.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.07.001

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I7/581

图/表 11

参考文献 24

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#1 2型糖尿病	#7 #1 and #3 in主题
#2益生菌	#8 #4 and #2 in主题
#3双歧杆菌	#9 #4 and #3 in主题
#4糖耐量受损	#10 (#1 or #4) and (#2 and #3) in主题
#6 #1 and #2 in主题	#11 (#1 or #4) and (#2 and #3) in摘要

#1 2型糖尿病	#7 #1 and #3 in主题
#2益生菌	#8 #4 and #2 in主题
#3双歧杆菌	#9 #4 and #3 in主题
#4糖耐量受损	#10 (#1 or #4) and (#2 and #3) in主题
#6 #1 and #2 in主题	#11 (#1 or #4) and (#2 and #3) in摘要

作者与年限	国家	干预组			对照组			干预方案		干预周期	结局指标	Cochrane 评分
		样本量 (例)		年龄 (岁)	样本量 (例)		年龄 (岁)	干预组	对照组
		样本量 (例)		年龄 (岁)	样本量 (例)		年龄 (岁)	乐忠宏^[5]2022	中国				80	59.4±6.1	45	58.1±5.3	二甲双胍+双歧杆菌四联活菌片 (3片/次,3次/d)	二甲双胍+保持饮食结构不变	12周	①②③	4分
Palacios^[6]2020	澳大利亚	14	61.4±8.9		14	56.1±12.3		二甲双胍+益生菌胶囊(含有植物乳杆菌Lp-115、保加利亚乳杆菌Lb-64、加氏乳杆菌Lg-36短双歧杆菌Bb-03、动物双歧杆菌lactisBi-07、双歧杆菌Bb-06、嗜热链球菌St-21、布拉氏酵母DBVPG 6763的胶囊)	二甲双胍+安慰剂(微晶纤维素,二氧化硅和硬脂酸镁)	12周	①②③④	5分
Tonucci^[7]2017	巴西	24	51.40±6.80		24	50.21±8.7		患者补充含有嗜酸乳杆菌La-5(6×10⁷ CFU/g)、乳酸双歧杆菌BB-12(2×10⁷CFU/g)的牛奶	补充安慰剂(牛奶)	6周	①②③④	5分
Toejing^[8]2021	泰国	18	61.78±7.73		18	63.50±5.94		补充含有益生菌的胶囊(副干酪乳杆菌HII01 50×10⁹CFU/g)	补充安慰剂(玉米淀粉)	12周	①②	4分
Khalili^[9]2019	伊朗	20	43.95±8.14		20	45±5.37		补充含有10⁸CFU/g干酪乳杆菌的胶囊	补充安慰剂(含有麦芽糖糊精)	8周	②③④	5分
Firouzi^[10]2017	伊朗	68	52.9±9.2		68	54.2±8.3		每包提供3×10¹⁰ CFU/g活微生物制剂粉末(其中每包粉末含有嗜酸乳杆菌,乳酸杆菌,双歧杆菌,长双歧杆菌)	补充安慰剂	12周	②③	5分
Alireza^[11]2017	伊朗	30	36~75		30	36~75		补充含有2×10⁹ CFU/g嗜酸乳杆菌、干酪乳杆菌、双歧双歧杆菌的胶囊	补充安慰剂	12周	①②③④	5分
Bayat^[12]2016	伊朗	20	46.95±9.34		20	54.1±9.54		补充含有益生菌的酸奶	饮食指导,保持饮食结构不变	8周	①②	4分
Asemi^[13]2015	伊朗	51	52.9±8.1		51	52.9±8.1		补充益生元的食品,其含有产孢乳杆菌1×10⁷ CFU/g	补充对照食品(不含益生菌)	6周	③④	5分
Mazloom^[14]2013	伊朗	16	55.4±8		18	51.8±10.2		补充含有嗜酸乳杆菌、保加利亚乳杆菌、双歧乳杆菌和干酪乳杆菌的胶囊	补充含有硬脂酸镁的胶囊	6周	①③	4分
Ostadrahimi^[15]2015	伊朗	30	48.29±11.71		30	51.4±8.6		补充600 ml有益生菌的发酵乳(其含有嗜酸乳杆菌、干酪乳杆菌、双歧杆菌)	补充600 ml普通乳品	8周	①③	4分

作者与年限	国家	干预组			对照组			干预方案		干预周期	结局指标	Cochrane 评分
		样本量 (例)		年龄 (岁)	样本量 (例)		年龄 (岁)	干预组	对照组
		样本量 (例)		年龄 (岁)	样本量 (例)		年龄 (岁)	乐忠宏^[5]2022	中国				80	59.4±6.1	45	58.1±5.3	二甲双胍+双歧杆菌四联活菌片 (3片/次,3次/d)	二甲双胍+保持饮食结构不变	12周	①②③	4分
Palacios^[6]2020	澳大利亚	14	61.4±8.9		14	56.1±12.3		二甲双胍+益生菌胶囊(含有植物乳杆菌Lp-115、保加利亚乳杆菌Lb-64、加氏乳杆菌Lg-36短双歧杆菌Bb-03、动物双歧杆菌lactisBi-07、双歧杆菌Bb-06、嗜热链球菌St-21、布拉氏酵母DBVPG 6763的胶囊)	二甲双胍+安慰剂(微晶纤维素,二氧化硅和硬脂酸镁)	12周	①②③④	5分
Tonucci^[7]2017	巴西	24	51.40±6.80		24	50.21±8.7		患者补充含有嗜酸乳杆菌La-5(6×10⁷ CFU/g)、乳酸双歧杆菌BB-12(2×10⁷CFU/g)的牛奶	补充安慰剂(牛奶)	6周	①②③④	5分
Toejing^[8]2021	泰国	18	61.78±7.73		18	63.50±5.94		补充含有益生菌的胶囊(副干酪乳杆菌HII01 50×10⁹CFU/g)	补充安慰剂(玉米淀粉)	12周	①②	4分
Khalili^[9]2019	伊朗	20	43.95±8.14		20	45±5.37		补充含有10⁸CFU/g干酪乳杆菌的胶囊	补充安慰剂(含有麦芽糖糊精)	8周	②③④	5分
Firouzi^[10]2017	伊朗	68	52.9±9.2		68	54.2±8.3		每包提供3×10¹⁰ CFU/g活微生物制剂粉末(其中每包粉末含有嗜酸乳杆菌,乳酸杆菌,双歧杆菌,长双歧杆菌)	补充安慰剂	12周	②③	5分
Alireza^[11]2017	伊朗	30	36~75		30	36~75		补充含有2×10⁹ CFU/g嗜酸乳杆菌、干酪乳杆菌、双歧双歧杆菌的胶囊	补充安慰剂	12周	①②③④	5分
Bayat^[12]2016	伊朗	20	46.95±9.34		20	54.1±9.54		补充含有益生菌的酸奶	饮食指导,保持饮食结构不变	8周	①②	4分
Asemi^[13]2015	伊朗	51	52.9±8.1		51	52.9±8.1		补充益生元的食品,其含有产孢乳杆菌1×10⁷ CFU/g	补充对照食品(不含益生菌)	6周	③④	5分
Mazloom^[14]2013	伊朗	16	55.4±8		18	51.8±10.2		补充含有嗜酸乳杆菌、保加利亚乳杆菌、双歧乳杆菌和干酪乳杆菌的胶囊	补充含有硬脂酸镁的胶囊	6周	①③	4分
Ostadrahimi^[15]2015	伊朗	30	48.29±11.71		30	51.4±8.6		补充600 ml有益生菌的发酵乳(其含有嗜酸乳杆菌、干酪乳杆菌、双歧杆菌)	补充600 ml普通乳品	8周	①③	4分