| Context : Non-alcoholic fatty liver disease(NAFLD)is a common chronic liver disease.The prevalence of NAFLD in the United States and Europe is about 10%-30%,and the global incidence is 25%.NAFLD is the second leading cause of liver transplantation.NAFLD is a common complication of metabolic diseases such as obesity,type 2 diabetes mellitus and hyperlipidemia.The pathogenesis of NAFLD has not been fully clarified.It has been observed that changes in the composition of intestinal microorganisms have significant effects on obesity and NAFLD.It is also found that intestinal microflora may participate in the pathogenesis of NAFLD through the intestinal-hepatic axis pathway.The mechanism is mainly related to the complex relationship between intestinal microorganisms and their metabolites and the liver functions such nutrition and detoxification.Probiotics are living microorganisms that can regulate intestinal flora.This association between NAFLD and intestinal flora has prompted researchers to study the efficacy of probiotics in the treatment of NAFLD.n consideration of the novelty of probiotics in the treatment of NAFLD,there is little evidence on the efficacy of probiotics in clinical studies,and some results are inconsistent.The effectiveness of probiotics in the treatment of NAFLD is still controversial.Objective:The purpose of this study was to systematically evaluate and quantitatively analyze the effects of probiotics on body mass index,serological indicators such as ALT,AST,TC,insulin resistance index,inflammatory index TNF and number of regression of fatty liver in patients with NAFLD.Methods:Retrieve the Chinese and English literatures on probiotics for NAFLD published in Pub Med,Cochrane,Medline,CNKI,Wanfang and VIP databases from May2008 to May 2018.According to the inclusion and exclusion criteria,the retrieval results were screened manually,and the literature quality was evaluated by using the NOS scale.Data such as body mass index,serological index,inflammatory index and imaging grade were extracted.Meta analysis was carried out by Rev Man 5.3 software;sensitivity analysis was carried out by Stata 12.0 software,and linear regression(Egger's)method was used.And rank correlation test(Begg's)was used to detect publication bias.Results:A total of 11 eligible randomized controlled studies were included.The totalnumber of cases was 650(326 cases in the treatment group and 324 cases in the control group).The types,course of treatment and dosage of probiotics were different among the studies.Meta-analysis showed that the levels of serum ALT(WMD=-12.49,95%CI:-16.67-8.31,P<0.00001),AST(WMD=-7.15,95% CI:-8.80-5.50,P<0.00001),TC(WMD=-0.34,95% CI:-0.54-0.13,P=0.001)in probiotic group were significantly lower than those in control group.Probiotics group could improve HOMA-IR(WMD=-0.36,95% CI:-0.51-0.21,P<0.00001)and increase the number of fatty liver regression(RR=4.20,95% CI:2.02-8.72,P=0.0001).But for BMI(WMD=-0.66,95% CI:-1.80-0.47,P=0.25),inflammatory index TNF(SMD=-0.47,95% CI:-0.96-0.01,P=0.05),there was no significant difference between probiotic group and control group.Subgroup analysis of the effect of probiotics on BMI of NAFLD patients showed that the compound preparation containing more than three probiotics(WMD=-2.33,95% CI:-2.90-1.76,P<0.00001)had obvious advantages in reducing BMI compared with one or two probiotics(WMD=-0.25,95% CI:-0.47-0.04,P=0.46).Conclusion : The results showed that probiotics could significantly reduce transaminase and total cholesterol,improve insulin resistance and increase the number of fatty liver regression in patients with NAFLD,but did not significantly reduce the level of body mass index and inflammatory index TNF.It was found that the compound probiotics containing three or more strains played a role in reducing BMI of NAFLD patients.The efficacy of probiotics in the treatment of NAFLD still needs a large number of high-quality,large-sample randomized controlled studies to confirm. |
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