Meta-analysis Of The Efficacy Of Probiotics On Cirrhosis

Purpose:Liver cirrhosis is liver fibrosis caused by long-term or repeated action of one or more factors(such as viruses,alcohol,drugs,metabolic disorders,cholestasis,etc.)and is the end stage of chronic liver disease.In the late stage,hepatic insufficiency and portal hypertension are common,and multiple system involvement occurs,leading to complications such as spontaneous peritonitis,hepatic encephalopathy,and liver cancer.It is currently recognized that patients with cirrhosis have varying degrees of intestinal flora imbalance,and intestinal flora imbalance will lead to destruction of the intestinal barrier,increase serum pro-inflammatory cytokines and alter hemodynamics,leading to progression of cirrhosis.Probiotics can reduce bacterial translocation,maintain intestinal microbiota composition,maintain intestinal barrier integrity and reduce intestinal inflammation,and improve liver function.At present,the clinical prospective randomized controlled trials of probiotics for the treatment of liver cirrhosis at home and abroad have a small sample size,and the reported efficacy also shows different results.Therefore,this paper evaluated the efficacy of probiotics in patients with liver cirrhosis by meta-analysis,and discusses the effects of probiotics on liver function and blood ammonia in patients with liver cirrhosis,and provides a reference for clinical rational drug use in patients with liver cirrhosis.Method:Search all the Chinese and English literatures related tocirrhosis and probiotics in the databases of Pubmed,Embase,Cochrane Library,China Knowledge Resource Pool(CNKI),Wip(VIP)and Wanfang database.Search for the search date from January 1,2008 to October 31,2018.After the inclusion and exclusion criteria were developed,the data of the selected literature were extracted,the quality of the literature was evaluated,and data analysis was performed using RevMan 5.3SOFTWARE.Result:According to the pre-defined search strategy,30 controlled studies were finally included in the screening,including the 5 English articles and 25 Chinese.The included studies were assessed according to the risk of bias provided by the Cochrane Collaboration.Twenty-two methodological quality evaluations were studies with high risk of bias and eight were studies with uncertain risk bias.A total of 30 articles included 1997 patients with cirrhosis,1006 cases in the experimental group(probiotics group)and 991 cases in the control group.Meta-analysis results showed that alanine aminotransferase(ALT)(SMD=-0.66,95% CI:-0.84 ~-0.47,P <0.00001),aspartate aminotransferase(AST)(SMD =-0.58,95% CI:-0.74 ~-0.41,P<0.00001),total bilirubin(TBIL)(SMD=-0.33,95% CI:-0.55 to-0.10,P=0.005),endotoxin(21days < course of treatment ? 28 days SMD =-0.78,95% CI:-1.01 ~-0.55,P <0.00001),blood ammonia(treatment course > 28 days SMD =-0.62,95% CI:-1.03 ~-0.22,P = 0.002),IL-6(SMD =-0.41,95% CI:-0.67 to-0.15,P = 0.002),TNF-?(SMD =-0.55,95% CI:-0.78 to-0.32,P < 0.00001),diamine oxidase level(SMD =-0.90,95% CI:-1.23 ~-0.58,P <0.00001),complication rate(RR = 0.45,95% CI: 0.32 ~ 0.62,P< 0.00001)probiotics group were lower than the control group,albumin two There was no significant difference between the groups(SMD=0.20,95% CI:-0.00~0.40,P=0.05).The total clinical effective rate probioticgroup was higher than the control group(RR=1.44,95% CI: 1.24~1.68,P<0.00001).Conclusion:The results of this meta-analysis indicate that treatment of probiotics in patients with cirrhosis may improve liver function,reduce blood ammonia levels,inhibit inflammatory response,regulate intestinal barrier function,and reduce complications.But the development of the best and most effective probiotic combination still requires more randomized clinical trials of higher quality.